Rapid Point-of-Care Influenza Testing for Patients in German Emergency Rooms – A Cost-Benefit Analysis

BACKGROUND: Each year, influenza causes significant morbidity and death worldwide and produces significant economic losses at the expense of the healthcare system. OBJECTIVE: To assess the cost-benefit relationship of implementing a rapid point-of-care (POC) influenza test in emergency rooms (ERs) of German hospitals. METHODS: A deterministic decision-analytic model simulated the incremental costs of using the Sofia(®) Influenza A+B test compared to those of using clinical judgement alone to confirm or exclude influenza in adult ILI (influenza-like illness) patients in German ERs prior to hospitalization. Direct costs, with and without subsequent oseltamivir treatment, were evaluated from the hospital perspective as well as indirect costs incurred by nosocomial influenza transmission to hospital employees. RESULTS: In base-case analysis, taking the influenza prevalence of 25.9% in the season 2018/2019 and assuming a hospitalization rate among influenza suspects of 21.9%, rapid testing with the Sofia(®) followed by administering oseltamivir to patients testing positive reduced average costs of hospitalized ILI patients by €52.16 per tested patient. If oseltamivir was not offered, testing with the Sofia(®) reduced costs by €42.28 in favor of the hospital. In probabilistic sensitivity analysis, under all reasonable assumptions, implementing the Sofia(®) saved on average €119.89 as compared to applying the clinical-judgement-only strategy. The major part of the cost savings, €113.17 or 94.4%, was due to the POC test’s high specificity, which led to 91% reduction in needless bed-blocking on the first day of hospitalization. However, as the sensitivity of 75.3% was only slightly higher than that of conventional clinical judgement, improved classification of patients with true influenza and a correspondingly lower rate of illness in hospital employees could not be achieved. CONCLUSIONS: Using highly specific rapid POC influenza tests in ILI patients at German ER, despite their sub-optimal sensitivity, may significantly reduce hospital expenditures.