Am J Infect Control . Performance- and cost-benefit analysis of an influenza point-of-care test compared to laboratory-based multiplex RT-PCR in the emergency department

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Am J Infect Control


. 2021 May 10;S0196-6553(21)00340-0.
doi: 10.1016/j.ajic.2021.04.087. Online ahead of print.
Performance- and cost-benefit analysis of an influenza point-of-care test compared to laboratory-based multiplex RT-PCR in the emergency department


Myrte van der Kraan ¹ , Elke L Hobbelink ² , Jayant Kalpoe ³ , Sjoerd M Euser ³ , Dominic Snijders ⁴ , Dennis Souverein ⁵



Affiliations

• PMID: 33984418
• DOI: 10.1016/j.ajic.2021.04.087

Abstract

Introduction: Influenza poses a heavy burden on emergency departments (ED) and hospital wards. Fast and reliable bedside tests are invaluable in obtaining indications for (cohort) droplet isolation precautions and improving patient flow. We performed a cost-benefit analysis comparing influenza point-of-care testing (POCT) to laboratory-based multiplex ligation-dependent probe amplification (MLPA).
Methods: Data of 275 ED presentations between January-April 2019 were analyzed. Patients received both POCT and MLPA to calculate POCT sensitivity and specificity. Costs were calculated for both a POCT and MLPA scenario, including costs for testing, admission, droplet isolation precautions and cleaning.
Results: In our study population, 34 patients (12%) were identified with influenza A. No cases of influenza B were identified. Mean(SD) age of the influenza positive patients was 75(18) years and 56% were male. The most common symptoms upon presentation were cough, malaise and fever, with 74%, 56% and 50%, respectively. Compared to MLPA, POCT yielded a sensitivity of 94%, a specificity of 98% and a negative predictive value of 99% for influenza A. Using POCT yielded a cost reduction of ?93,26 per patient.
Conclusion: Influenza POCT is an accurate and cost-beneficial method to differentiate between admission with or without droplet isolation precautions. It can be useful in clinical decision making and reducing pressure on ED and hospital beds in an influenza peak season, by enabling fast patient flow and cohort isolation.

Keywords: Influenza; cost-benefit; emergency department; point-of-care testing (POCT); reverse transcriptase polymerase chain reaction (RT-PCR).