Point of Care Nucleic Acid Testing for Influenza-Like Illness: A Cost–Consequence Analysis for High-Risk Patients in Primary Care in Germany
Year: 2025
Type: article
Abstract: Influenza A/B virus, severe acute respiratory coronavirus 2 (SARS-CoV-2), and respiratory syncytial virus (RSV) cause similar symptoms, often referred to as influenza-like illness, but require different treatments which must be administered within a short timeframe after symptom onset. This necessitates rapid detection and accurate differentiation by primary care providers, ideally at point of care (POC). POC nucleic acid tests such as the multiplex, real-time polymerase chain reaction (PCR) Xpert® Xpress CoV-2/Flu/RSV plus (Xpert Xpress) offer a faster, more accurate alternative compared to antigen testing, clinical judgement alone, or send-out PCR. This cost–consequence analysis evaluated Xpert Xpress versus conventional testing methods, from a German statutory health insurance (SHI) perspective. A 1-year decision tree was developed to compare Xpert Xpress with antigen testing, send-out PCR, and empiric diagnosis, for influenza A/B virus, SARS-CoV-2, and RSV. The model accounted for diagnostic accuracy and projected the share of patients receiving results within guideline-recommended treatment windows. Data on test accuracy, treatment effects, and costs were sourced from literature and German databases. The main outcome was total cost to the SHI for the 2023/24 respiratory illness season. Xpert Xpress was associated with the highest number of net correct treatment courses (n = 443,600) versus empiric diagnosis (n = 239,250), antigen testing (n = 347,218), and send-out PCR (n = 280,527). Acquisition costs were highest for Xpert Xpress (EUR 38.4 million versus EUR 27.4 million for antigen testing and EUR 33.5 million for send-out PCR) but were offset by reduced hospitalization and intensive care costs. Overall, Xpert Xpress was associated with cost savings of EUR 1.97 million versus empiric diagnosis, EUR 10.1 million versus antigen testing, and EUR 20.8 million versus send-out PCR. Using Xpert Xpress at POC combined fast turnaround with high diagnostic accuracy, thereby increasing correct treatment courses while reducing total costs for influenza, COVID-19, and RSV, offering substantial savings to the German SHI. Influenza, SARS-COV-2, and respiratory syncytial virus cause similar symptoms, referred to as influenza-like illness, but require different treatments. It is important for physicians to quickly and accurately identify the virus to provide the right antiviral treatment in time to be most effective. Traditional testing methods, like sending samples to a laboratory or antigen tests, can be associated with long turnaround or limited diagnostic accuracy. In comparison, point of care molecular tests such as the Xpert® Xpress CoV-2/Flu/RSV plus test (Xpert® Xpress) can provide a diagnosis with both high accuracy and short turnaround times. This study compared the costs and benefits of point of care molecular testing using Xpert Xpress with common testing methods in Germany. The analysis projected the number of correct treatment courses following each test, associated resource use, and total and test costs, from the German statutory healthcare insurance perspective. The results indicated that Xpert Xpress provides the highest number of correct treatment courses versus antigen tests, sending samples to an external laboratory, and diagnosing patients based on symptoms. While Xpert Xpress has higher upfront costs, it saves money overall by reducing hospitalizations and intensive care, including nearly €2 million versus diagnosis without testing, over €10 million versus antigen testing, and nearly €21 million versus sending tests to external laboratories. In conclusion, point of care molecular testing was found to reduce time and costs associated with diagnosing common respiratory viruses versus alternative testing methods, leading to improved treatment patterns and lower overall costs to German statutory healthcare insurance.
Source: Advances in Therapy
Authors: Johannes Pöhlmann, Anika Joecker, Tanja Wittki, Tray Brown, Richard F. Pollock, Jordan Chase
Institutions: Covalence Research, Cepheid (United States)
Language: English
Subfield: Economics and Econometrics
Domain: Social Sciences
Open Access status: hybrid
Estimated APC paid: $4,790
Funder: Cepheid
OpenAlex ID: W4408743017