1261. Economic Analysis of Rapid and Highly Sensitive PCR Testing for Viral Respiratory Infections in Children with Influenza Like Illness
Session: Oral Abstract Session: Respiratory Viral Infections in Children
Saturday, October 5, 2013: 11:45 AM
Room: The Moscone Center: 200-212
Background:

Multiplex polymerase chain reaction (PCR) systems can identify many viral pathogens with a single test. Fast viral diagnostic results can reduce ancillary testing and antibiotics while facilitating use of antivirals. This study compared the cost-effectiveness of FilmArray with about a 1-hour time to result to alternative diagnostic tests for viral respiratory infections.

Methods:

We used decision analysis to compare costs and outcomes for children 3-35 mos and 3-17 yrs presenting to the emergency department (ED) with influenza-like illness (ILI) using 4 testing strategies: 1) FilmArray, 2) traditional PCR methods, 3) direct fluorescent antibody (DFA), and 4) rapid antigen tests. Costs were from the hospital perspective and effectiveness was true cases of viral infection (influenza, respiratory syncytial virus, or other) detected. Based on timing and test results, patients might receive additional laboratory tests, antibiotics, or be hospitalized. Hospitalization cost was $9,148 and the cost of testing varied from $22 (rapid antigen test and DFA) to $232 (FilmArray). Cost and probability inputs were based on the literature and data from Primary Children’s Medical Center. Models varied influenza prevalence from 10-30%.

Results:

For a hypothetical population of 1,000 pediatric ED patients 3-35 mos, FilmArray detected 32-161 more infections and resulted in cost savings of $1,400-$238,000 compared to the 3 alternative testing strategies depending on the prevalence assumption. In sensitivity analyses, FilmArray ceased to be the least expensive testing strategy if the assumed cost of the test exceeded $345 or with a 17% increase in the probability of hospitalization based on a fast, positive test result. For children 3-17 yrs, FilmArray was the most effective strategy and was less costly than PCR and DFA. For this group, the incremental cost-effectiveness ratio of FilmArray compared to rapid antigen tests ranged from $529-$3000/additional case detected. 

Conclusion:

In a hypothetical pediatric ED population, FilmArray was the most effective testing strategy for both age groups and was the least costly testing strategy for children 3-35 mos. These results, while sensitive to several key parameters, present a compelling economic argument for rapid, accurate, multiplex viral testing in children with ILI.

Richard E. Nelson, PhD1,2, Chris Stockmann, MSc3, Adam L. Hersh, MD, PhD4, Andrew Pavia, MD, FIDSA, FSHEA3, E. Kent Korgenski, MS5, Judy A. Daly, PhD6, Marc Roger Couturier, Ph.D., D(ABMM)7, Krow Ampofo, MD8, Emily A. Thorell, MD, MSci3, Elizabeth Doby, MD3 and Anne J. Blaschke, MD, PhD3, (1)VA Salt Lake City Healthcare System, Salt Lake City, UT, (2)Internal Medicine, University of Utah, Salt Lake City, UT, (3)Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, (4)Pediatrics, University of Utah Health Science Center, Salt Lake City, UT, (5)Department of Pediatrics, Pediatric Clinical Program, University of Utah School of Medicine and Intermountain Healthcare, Salt Lake City, UT, (6)Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, (7)Pathology, University of Utah, Salt Lake City, UT, (8)Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah Scjpp; Pf
Disclosures:

R. E. Nelson, None

C. Stockmann, None

A. L. Hersh, None

A. Pavia, None

E. K. Korgenski, None

J. A. Daly, None

M. R. Couturier, None

K. Ampofo, None

E. A. Thorell, None

E. Doby, None

A. J. Blaschke, BioFire Diagnostics, Inc.: Collaborator, Licensing agreement or royalty

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