PMID- 33196653
OWN - NLM
STAT- MEDLINE
DCOM- 20210105
LR  - 20231104
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 15
IP  - 11
DP  - 2020
TI  - Point-of-care diagnostic tests for influenza in the emergency department: A 
      cost-effectiveness analysis in a high-risk population from a Canadian 
      perspective.
PG  - e0242255
LID - 10.1371/journal.pone.0242255 [doi]
LID - e0242255
AB  - BACKGROUND: Our objective was to assess the cost-effectiveness of novel rapid 
      diagnostic tests: rapid influenza diagnostic tests (RIDT), digital immunoassays 
      (DIA), rapid nucleic acid amplification tests (NAAT), and other treatment 
      algorithms for influenza in high-risk patients presenting to hospital with 
      influenza-like illness (ILI). METHODS: We developed a decision-analytic model to 
      assess the cost-effectiveness of diagnostic test strategies (RIDT, DIA, NAAT, 
      clinical judgement, batch polymerase chain reaction) preceding treatment; no 
      diagnostic testing and treating everyone; and not treating anyone. We modeled 
      high-risk 65-year old patients from a health payer perspective and accrued 
      outcomes over a patient's lifetime. We reported health outcomes, quality-adjusted 
      life years (QALYs), healthcare costs, and net health benefit (NHB) to measure 
      cost-effectiveness per cohort of 100,000 patients. RESULTS: Treating everyone 
      with no prior testing was the most cost-effective strategy, at a 
      cost-effectiveness threshold of $50,000/QALY, in over 85% of simulations. This 
      strategy yielded the highest NHB of 15.0344 QALYs, but inappropriately treats all 
      patients without influenza. Of the novel rapid diagnostics, NAAT resulted in the 
      highest NHB (15.0277 QALYs), and the least number of deaths (1,571 per 100,000). 
      Sensitivity analyses determined that results were most impacted by the pretest 
      probability of ILI being influenza, diagnostic test sensitivity, and treatment 
      effectiveness. CONCLUSIONS: Based on our model, treating high-risk patients 
      presenting to hospital with influenza-like illness, without performing a novel 
      rapid diagnostic test, resulted in the highest NHB and was most cost-effective. 
      However, consideration of whether treatment is appropriate in the absence of 
      diagnostic confirmation should be taken into account for decision-making by 
      clinicians and policymakers.
FAU - Mac, Stephen
AU  - Mac S
AUID- ORCID: 0000-0003-4736-1770
AD  - Institute of Health Policy, Management and Evaluation (IHPME), University of 
      Toronto, Toronto, Canada.
AD  - Toronto Health Economics and Technology Assessment (THETA) Collaborative, 
      University Health Network, Toronto, Canada.
FAU - O'Reilly, Ryan
AU  - O'Reilly R
AD  - Institute of Health Policy, Management and Evaluation (IHPME), University of 
      Toronto, Toronto, Canada.
AD  - Toronto Health Economics and Technology Assessment (THETA) Collaborative, 
      University Health Network, Toronto, Canada.
AD  - Department of Medicine, McMaster University, Hamilton, Canada.
FAU - Adhikari, Neill K J
AU  - Adhikari NKJ
AUID- ORCID: 0000-0003-4038-5382
AD  - Institute of Health Policy, Management and Evaluation (IHPME), University of 
      Toronto, Toronto, Canada.
AD  - Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, 
      Canada.
AD  - Interdepartmental Division of Critical Care Medicine, University of Toronto, 
      Toronto, Canada.
FAU - Fowler, Robert
AU  - Fowler R
AD  - Institute of Health Policy, Management and Evaluation (IHPME), University of 
      Toronto, Toronto, Canada.
AD  - Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, 
      Canada.
AD  - Interdepartmental Division of Critical Care Medicine, University of Toronto, 
      Toronto, Canada.
FAU - Sander, Beate
AU  - Sander B
AD  - Institute of Health Policy, Management and Evaluation (IHPME), University of 
      Toronto, Toronto, Canada.
AD  - Toronto Health Economics and Technology Assessment (THETA) Collaborative, 
      University Health Network, Toronto, Canada.
AD  - ICES, Toronto, Canada.
AD  - Public Health Ontario, Toronto, Canada.
LA  - eng
GR  - GSD-159274/CIHR/Canada
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20201116
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
SB  - IM
MH  - Aged
MH  - Canada
MH  - *Cost-Benefit Analysis
MH  - Emergency Service, Hospital/economics
MH  - Female
MH  - Health Care Costs
MH  - Humans
MH  - Immunoassay/economics
MH  - Influenza, Human/*diagnosis/mortality/therapy
MH  - Male
MH  - Nucleic Acid Amplification Techniques/economics
MH  - Point-of-Care Testing/*economics
MH  - Quality-Adjusted Life Years
PMC - PMC7668582
COIS- NKJA co-chaired the WHO Guideline Development Group - Clinical Management of 
      Severe Influenza Infections. This does not alter our adherence to PLOS ONE 
      policies on sharing data and materials. All remaining authors have no conflicts 
      of interest to declare.
EDAT- 2020/11/17 06:00
MHDA- 2021/01/06 06:00
PMCR- 2020/11/16
CRDT- 2020/11/16 14:48
PHST- 2020/05/22 00:00 [received]
PHST- 2020/10/30 00:00 [accepted]
PHST- 2020/11/16 14:48 [entrez]
PHST- 2020/11/17 06:00 [pubmed]
PHST- 2021/01/06 06:00 [medline]
PHST- 2020/11/16 00:00 [pmc-release]
AID - PONE-D-20-15378 [pii]
AID - 10.1371/journal.pone.0242255 [doi]
PST - epublish
SO  - PLoS One. 2020 Nov 16;15(11):e0242255. doi: 10.1371/journal.pone.0242255. 
      eCollection 2020.