Economic and operational impact of an improved pathway using rapid molecular diagnostic testing for patients with influenza-like illness in a German emergency department

Matthias Brachmann,Clemens Kill,Katja Kikull,Susanne Betz

doi:10.1007/s10877-018-00243-2

Abstract

To evaluate the economic and operational effects of implementing a shorted diagnostic pathway during influenza epidemics. This retrospective study used emergency department (ED) data from the 2014/2015 influenza season. Alere i influenza A & B rapid molecular diagnostic test (RDT) was compared with the polymerase chain reaction (PCR) pathway. Differences in room occupancy time in the ED and inpatient ward and cost differences were calculated for the 14-week influenza season. The process flow was more streamlined with the RDT pathway, and the necessary isolation time in the ED was 9 h lower than for PCR. The difference in the ED examination room occupancy time was 2.9 h per patient on a weekday and 4 h per patient on a weekend day, and the difference in the inpatient room occupancy time was 2 h per patient on a weekday and 3 h per patient on a weekend day. Extrapolated time differences across the influenza season were projected to be 2733 h in the ED examination room occupancy and 1440 h in inpatient room occupancy. In patients with a negative diagnosis, the RDT was also estimated to reduce the total diagnostic costs by 41.52 € per patient compared with PCR. The total cost difference was projected to be 31,892 € across a 14-week influenza season. The improved process and earlier diagnosis with the RDT pathway compared with conventional PCR resulted in considerable savings in ED, inpatient room occupancy time and cost across the influenza season.

Highlights

Seasonal influenza epidemics are a huge global burden
Data obtained from the rapid molecular diagnostic test (RDT) for the analysed week of the 2015 influenza epidemic indicated that 5.3% of patients were tested for influenza; approximately 812 patients would have been tested during the whole influenza epidemic. 31% of the tested patients were positive
There is a paucity of evidence on the economic and functional benefits of using rapid molecular diagnostic tests for the detection of influenza during an influenza epidemic

Summary

Introduction

Seasonal influenza epidemics are a huge global burden. They typically infect 5–15% of the population during an epidemic [1], cause 250,000–500,000 deaths annually worldwide [2], and are associated with a significant number of related hospitalizations [3]. There is, a delay before the results are available, which is a particular issue during weekends and public holidays, when laboratory diagnostic facilities are frequently unavailable [5, 6], and during influenza epidemics, when diagnostic laboratories do not have the capacity to sustain demand [7]. This has implications for patient flow and infection control [8], and patients may need to remain in multi-bed rooms in the emergency department (ED) until a suitable room becomes available [9]. Delays in the diagnosis of influenza have been associated with inferior outcomes, including disease progression and mortality [8, 10]

Methods

Results

Conclusion