A cost-consequence analysis of the Xpert Xpress CoV-2/Flu/RSV plus test strategy for the diagnosis of influenza-like illnesses.

IF 2.9 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Journal of Medical Economics Pub Date : 2024-01-01 Epub Date: 2024-03-11 DOI:10.1080/13696998.2024.2313391
Shawn Davies, Emily Boller, Jordan Chase, Anne Beaubrun, Cynthia Miller, Ivar Jensen
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Abstract

Aims: Influenza-like illnesses (ILI) affect millions each year in the United States (US). Determining definitively the cause of symptoms is important for patient management. Xpert Xpress CoV-2/Flu/RSV plus (Xpert Xpress) is a rapid, point-of-care (POC), multiplex real-time polymerase chain reaction (RT-PCR) test intended for the simultaneous qualitative detection and differentiation of SARS-CoV-2, influenza A/B, and respiratory syncytial virus (RSV). The objective of our analysis was to develop a cost-consequence model (CCM) demonstrating the clinico-economic impacts of implementing PCR testing with Xpert Xpress compared to current testing strategies.

Methods: A decision tree model, with a 1-year time horizon, was used to compare testing with Xpert Xpress alone to antigen POC testing and send-out PCR strategies in the US outpatient setting from a payer perspective. A hypothetical cohort of 1,000,000 members was modeled, a portion of whom develop symptomatic ILIs and present to an outpatient care facility. Our main outcome measure is cost per correct treatment course.

Results: The total cost per correct treatment course was $1,131 for the Xpert Xpress strategy compared with a range of $3,560 to $5,449 in comparators. POC antigen testing strategies cost more, on average, than PCR strategies.

Limitations: Simplifying model assumptions were used to allow for modeling ease. In clinical practice, treatment options, costs, and diagnostic test sensitivity and specificity may differ from what is included in the model. Additionally, the most recent incidence and prevalence data was used within the model, which is not reflective of historical averages due to the SARS-CoV-2 pandemic.

Conclusion: The Xpert Xpress CoV-2/Flu/RSV plus test allows for rapid and accurate diagnostic results, leading to reductions in testing costs and downstream healthcare resource utilization compared to other testing strategies. Compared to POC antigen testing strategies, PCR strategies were more efficient due to improved diagnostic accuracy and reduced use of confirmatory testing.

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用于诊断流感样疾病的 Xpert Xpress CoV-2/Flu/RSV plus 检测策略的成本-后果分析。
目的:美国每年有数百万人感染流感样疾病(ILI)。明确确定症状的病因对患者的治疗非常重要。Xpert Xpress CoV-2/Flu/RSV plus(Xpert Xpress)是一种快速、床旁(POC)、多重实时聚合酶链反应(RT-PCR)检验,用于同时定性检测和区分 SARS-CoV-2、A/B 型流感和呼吸道合胞病毒(RSV)。我们的分析目的是建立一个成本-后果模型(CCM),说明与目前的检测策略相比,使用 Xpert Xpress 进行 PCR 检测的临床经济影响:方法: 从支付方的角度出发,使用一个时间跨度为 1 年的决策树模型,比较在美国门诊环境中仅使用 Xpert Xpress 进行检测与抗原 POC 检测和送出 PCR 策略。我们模拟了一个由 1,000,000 名会员组成的假定群组,其中一部分会员出现了无症状的 ILI 并前往门诊医疗机构就诊。我们的主要结果指标是每个正确疗程的成本:结果:Xpert Xpress 策略每个正确疗程的总成本为 1,131 美元,而比较者的成本范围为 3,560 美元至 5,449 美元。POC 抗原检测策略的平均成本高于 PCR 策略:为便于建模,使用了简化模型假设。在临床实践中,治疗方案、成本、诊断检测的敏感性和特异性可能与模型中的假设不同。此外,模型中使用的是最新的发病率和流行率数据,由于 SARS-CoV-2 大流行,这些数据并不能反映历史平均水平:结论:Xpert Xpress CoV-2/Flu/RSV+检测可提供快速、准确的诊断结果,与其他检测策略相比,可降低检测成本和下游医疗资源利用率。与 POC 抗原检测策略相比,PCR 策略更有效,因为它提高了诊断的准确性,减少了确证检测的使用。
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来源期刊
Journal of Medical Economics
Journal of Medical Economics HEALTH CARE SCIENCES & SERVICES-MEDICINE, GENERAL & INTERNAL
CiteScore
4.50
自引率
4.20%
发文量
122
期刊介绍: Journal of Medical Economics'' mission is to provide ethical, unbiased and rapid publication of quality content that is validated by rigorous peer review. The aim of Journal of Medical Economics is to serve the information needs of the pharmacoeconomics and healthcare research community, to help translate research advances into patient care and be a leader in transparency/disclosure by facilitating a collaborative and honest approach to publication. Journal of Medical Economics publishes high-quality economic assessments of novel therapeutic and device interventions for an international audience
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