Cost–Benefit Analysis of Real-Time Influenza Testing for Patients in German Emergency Rooms
Abstract
:1. Introduction
1.1. Test System
1.2. Ethical Considerations
2. Materials and Methods
2.1. Model Approach
2.2. Model Structure
2.3. Model Input
2.3.1. Epidemiological and Laboratory Parameters
Prevalence of Influence in Season 2017/2018
Sensitivity and Specificity of Clinical Judgement
Sensitivity and Specificity of the Real-Time Influenza Test (Solana®)
Rate of Hospitalizations
Vaccination rate and its effectiveness among HCW
Secondary Attack Rate after Influenza Virus Transmission
2.3.2. Economic Parameters
Costs of the Rapid Influenza Test
Costs of External PCR
Hospital Opportunity Costs
Costs of Initial Treatment with Neuraminidase Inhibitors
Revenue from Administering a Neuraminidase Inhibitor
Costs of Intrahospital Transmission
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Variables Category | Variable Name | Distribution * | Value (Base Case) | Relative Change (Range) | Reference |
---|---|---|---|---|---|
Prevalence of influenza | Flu_prev | triangular | 0.426 | 0.2–0.426 | Calculated from [2] |
Additional revenue per day due to NI | cRev_day | uniform | €233.46 | ±20% (€186.77–280.15 | Calculated from InEK data [18] |
Combined Solana® specificity | Solana_spec | uniform | 0.96.7 | (95% CI) 0.954–0.977 | [19] |
Opportunity costs due to blocking twin bed | cOpp | triangular | €350.19 | ±20% (€280.15–€420.23) | Calculated from InEK data [18] |
Probability of correctly excluding non-influenza | Clin_spec | uniform | 0.601 | 95% CI (65.4–76.7) | [20] |
Sensitivity of diagnosing influenza if present | Clin_sens | uniform | 0.713 | 95% CI (0.65–76.7) | [20] |
Costs of virustatics per day | cAntivir_day | triangular | €12.37 | ±20% (€9.89–€14.83) | Adapted from Rote Liste 2019 |
Costs of Solana® | cSolana | triangular | €14 | ±20% (€11.20–€16.80) | As declared by manufacturer |
Combined sensitivity of the Solana® test | Solana_sens | triangular | 0.972 | 95% CI (0.954–0.984) | [19] |
Secondary cases due to one unknown influenza case | sec_flu | normal | 0.202 | 95% CI (0154–0.256) | [21] |
Costs of productivity loss per day | cPL_day | triangular | €156. | ±20% (€125.59–€188.39) | calculated from Federal Statistical Office data [22] |
Number of days of HCW out of work due to influenza | sick_days | normal | 7.2 10.32 days | ±SD 8.9 days (5.76–8.64) | [23,24] |
Probability of vaccinated HCW | pVacc_HCW | normal | 0.401 | ±20% (0.33–0.49) | [25] |
Probability that hospitalization is required | pHosp | uniform | 0.18 | 0.157–0.23 | Adapted from [1] |
Costs of PCR in external laboratory | cPCR | uniform | €44.88 | €30-65–€7.56 | Nationwide laboratory inquiry |
Effectiveness of influenza vaccination | Vacc_eff | uniform | 0.15 | 0.15–0.49 | [1,26] |
Base-Case Analysis | Comparators | Mean Cost Per Patient (€) | Incremental Cost (€) * | Absolute Cost Savings (€) |
---|---|---|---|---|
ILI patients prior to hospitalisation followed by immediate intake of NI | Solana® as an add-on | −6.90 | 0 | −6.90 |
Conventional approach | 125.71 | 132.61 |
Variable Name | Variable Description | Variable Lowest Bound | Variable Highest Bound | Lowest cost Value | Highest Costs Value | Spread Ƭ | Threshold Value µ | Risk % ¥ | Cumulative Risk% |
---|---|---|---|---|---|---|---|---|---|
Flu_prev | Prevalence of influenza | 0.20 | 0.43 | −6.90 | 48.19 | 55.09 | <0.398 | 0.49 | 0.49 |
cRev_day | Additional revenue per day due to NI | 186.77 | 280.15 | −26.23 | 12.43 | 38.67 | <217.10 | 0.24 | 0.74 |
Solana_spec | Combined Solana® specificity | 0.95 | 0.98 | −21.32 | 11.86 | 33.18 | <0.9622 | 0.18 | 0.92 |
cOpp | Opportunity costs due to blocking twin bed | 280.15 | 420.23 | −16.19 | 2.39 | 18.57 | >402.37 | 0.06 | 0.97 |
cAntivir_day | Costs of virustatics per day | 9.89 | 14.83 | −12.27 | −1.57 | 10.70 | - | 0.02 | 0.99 |
cSolana | Costs of Solana® | 11.20 | 16.80 | −9.70 | −4.10 | 5.60 | - | 0.01 | 0.99 |
Solana_sens | Combined sensitivity of the Solana® test | 0.95 | 0.98 | −8.87 | −3.28 | 5.59 | - | 0.01 | 1.00 |
sec_flu | Secondary cases due to one unknown influenza case | 0.15 | 0.26 | −7.50 | −6.21 | 1.29 | - | 0.00 | 1.00 |
cPL_day | Costs of productivity loss per day | 125.59 | 188.39 | −7.41 | −6.39 | 1.02 | - | 0.00 | 1.00 |
sick_days | Number of days of HCW out of work due to influenza | 5.76 | 8.64 | −7.41 | −6.39 | 1.02 | - | 0.00 | 1.00 |
Vacc_eff | Effectiveness of influenza vaccination | 0.15 | 0.49 | −7.28 | −6.90 | 0.38 | - | 0.00 | 1.0 |
pVacc_HCW | Probability of HCW being vaccinated | 0.33 | 0.49 | −6.93 | −6.86 | 0.07 | - | 0.00 | 1.00 |
pHosp | Probability that hospitalization is required | 0.16 | 0.23 | −6.90 | −6.90 | 0.00 | - | 0.00 | 1.00 |
Clin_sens | Sensitivity of diagnosing influenza if present | 0.65 | 0.77 | −6.90 | −6.90 | 0.00 | - | 0.00 | 1.00 |
Clin_spec | Probability of correctly excluding non-influenza | 0.57 | 0.63 | −6.90 | −6.90 | 0.00 | - | 0.00 | 1.00 |
cPCR_ext | Costs of PCR in external laboratory | 30.00 | 65.00 | −6.90 | −6.90 | 0.00 | 0.00 | 1.00 |
Probabilistic Sensitivity Analysis | Comparators | Mean Cost Per Patient (€) | Standard Deviation (± SD) | Incremental Cost (€) * |
---|---|---|---|---|
ILI patients prior to hospitalisation followed by immediate intake of NI | Solana® as an add-on | 12.92 | 24.66 | 0 |
Conventional approach | 157.05 | 24.68 | 144.13 |
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Diel, R.; Nienhaus, A. Cost–Benefit Analysis of Real-Time Influenza Testing for Patients in German Emergency Rooms. Int. J. Environ. Res. Public Health 2019, 16, 2368. https://doi.org/10.3390/ijerph16132368
Diel R, Nienhaus A. Cost–Benefit Analysis of Real-Time Influenza Testing for Patients in German Emergency Rooms. International Journal of Environmental Research and Public Health. 2019; 16(13):2368. https://doi.org/10.3390/ijerph16132368
Chicago/Turabian StyleDiel, Roland, and Albert Nienhaus. 2019. "Cost–Benefit Analysis of Real-Time Influenza Testing for Patients in German Emergency Rooms" International Journal of Environmental Research and Public Health 16, no. 13: 2368. https://doi.org/10.3390/ijerph16132368