Pöhlmann Johannes, Joecker Anika, Wittki Tanja, Brown Tray, Pollock Richard F, Chase Jordan
Covalence Research Ltd, Rivers Lodge, West Common, Harpenden, AL5 2JD, UK.
Cepheid GmbH, Krefeld, Germany.
Adv Ther. 2025 May;42(5):2385-2402. doi: 10.1007/s12325-025-03156-0. Epub 2025 Mar 22.
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.
甲型/乙型流感病毒、严重急性呼吸综合征冠状病毒2（SARS-CoV-2）和呼吸道合胞病毒（RSV）会引发相似症状，通常被称为流感样疾病，但需要不同的治疗方法，且必须在症状出现后的短时间内进行治疗。这就需要初级保健提供者进行快速检测和准确鉴别，理想情况下是在护理点（POC）进行。与抗原检测、单纯临床判断或送检聚合酶链反应（PCR）相比，POC核酸检测，如多重实时PCR Xpert Xpress CoV-2/Flu/RSV plus（Xpert Xpress）提供了一种更快、更准确的选择。这项成本效益分析从德国法定健康保险（SHI）的角度评估了Xpert Xpress与传统检测方法。
开发了一个为期1年的决策树，以比较Xpert Xpress与抗原检测、送检PCR和经验性诊断在甲型/乙型流感病毒、SARS-CoV-2和RSV检测中的效果。该模型考虑了诊断准确性，并预测了在指南推荐的治疗窗口期内获得检测结果的患者比例。检测准确性、治疗效果和成本的数据来自文献和德国数据库。主要结果是2023/24呼吸道疾病季节SHI的总成本。
与经验性诊断（n = 239,250）、抗原检测（n = 347,218）和送检PCR（n = 280,527）相比，Xpert Xpress的正确治疗疗程净数最高（n = 443,600）。Xpert Xpress的购置成本最高（3840万欧元，抗原检测为2740万欧元，送检PCR为3350万欧元），但因住院和重症监护成本的降低而得到抵消。总体而言，与经验性诊断相比，Xpert Xpress节省成本197万欧元，与抗原检测相比节省1010万欧元，与送检PCR相比节省2080万欧元。
在护理点使用Xpert Xpress可将快速周转与高诊断准确性相结合，从而增加正确治疗疗程，同时降低流感、新冠肺炎和RSV的总成本，为德国SHI节省大量资金。
