Nelson Richard E, Stockmann Chris, Hersh Adam L, Pavia Andrew T, Korgenksi Kent, Daly Judy A, Couturier Marc R, Ampofo Krow, Thorell Emily A, Doby Elizabeth H, Robison Jeff A, Blaschke Anne J
From the *IDEAS Center, Salt Lake City Veterans Affairs Health Care System, Salt Lake City, UT; †Department of Internal Medicine, ‡Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT; §Intermountain Healthcare, Pediatric Clinical Program, Salt Lake City, UT; ¶Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT; and ‖Associated Regional and University Pathologists, Inc., Institute for Clinical and Experimental Pathology, Salt Lake City, UT.
Pediatr Infect Dis J. 2015 Jun;34(6):577-82. doi: 10.1097/INF.0000000000000703.
Rapid multiplex polymerase chain reaction (PCR) assays simultaneously detect several respiratory viral pathogens with high sensitivity. Maximizing detection of influenza at the point of care has the potential to reduce unnecessary antibiotic use, laboratory tests and hospitalizations. However, the cost-effectiveness of rapid multiplex PCR assays for influenza has not been compared with other diagnostic methods in children.
For children presenting to the emergency department with influenza-like illness, we compared costs and outcomes using 4 different testing strategies for detection of influenza: (1) a rapid multiplex PCR platform (FilmArray); (2) traditional PCR; (3) direct-fluorescent antibody and (4) rapid antigen tests. Costs were assessed from the hospital perspective, and effectiveness was defined as quality-adjusted life years (QALYs). Input parameters were obtained from previous studies, and the model was run separately for children aged 3-36 months and 3-18 years.
Rapid multiplex PCR testing was the most effective testing strategy for children in both age groups. The incremental cost-effectiveness when compared with rapid antigen tests was $115,556 per QALY for children aged 3-36 months and from $228,000 per QALY for children aged 3-18 years. The cost-effectiveness of rapid multiplex PCR was sensitive to estimates for influenza prevalence, the proportion of patients treated with antivirals and the cost per test.
Our model identifies scenarios in which identification of influenza in the emergency department using rapid multiplex PCR testing is a cost-effective strategy for infants and children 3 months through 18 years. Including detection of other respiratory viruses in the analysis would further improve cost-effectiveness.
快速多重聚合酶链反应（PCR）检测可同时高灵敏度地检测多种呼吸道病毒病原体。在医疗点最大限度地检测流感病毒有潜力减少不必要的抗生素使用、实验室检查和住院治疗。然而，快速多重PCR检测流感的成本效益尚未与儿童的其他诊断方法进行比较。
对于因流感样疾病到急诊科就诊的儿童，我们使用4种不同的流感检测策略比较了成本和结果：（1）快速多重PCR平台（FilmArray）；（2）传统PCR；（3）直接荧光抗体检测和（4）快速抗原检测。从医院角度评估成本，有效性定义为质量调整生命年（QALY）。输入参数来自先前的研究，该模型分别针对3至36个月和3至18岁的儿童运行。
快速多重PCR检测是两个年龄组儿童中最有效的检测策略。与快速抗原检测相比，3至36个月儿童每获得一个QALY的增量成本效益为115,556美元，3至18岁儿童每获得一个QALY的增量成本效益为228,000美元。快速多重PCR的成本效益对流感患病率、接受抗病毒治疗的患者比例和每次检测成本的估计很敏感。
我们的模型确定了在急诊科使用快速多重PCR检测识别流感的情况，对于3个月至18岁的婴幼儿和儿童来说是一种具有成本效益的策略。在分析中纳入其他呼吸道病毒的检测将进一步提高成本效益。
