title: Economic analysis of rapid and sensitive polymerase chain reaction testing in the emergency department for influenza infections in children.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Nelson
authors.forename: Chris
authors.initials: C
authors.lastname: Stockmann
authors.forename: Adam L
authors.initials: AL
authors.lastname: Hersh
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Pavia
authors.forename: Kent
authors.initials: K
authors.lastname: Korgenksi
authors.forename: Judy A
authors.initials: JA
authors.lastname: Daly
authors.forename: Marc R
authors.initials: MR
authors.lastname: Couturier
authors.forename: Krow
authors.initials: K
authors.lastname: Ampofo
authors.forename: Emily A
authors.initials: EA
authors.lastname: Thorell
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Doby
authors.forename: Jeff A
authors.initials: JA
authors.lastname: Robison
authors.forename: Anne J
authors.initials: AJ
authors.lastname: Blaschke
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D004635:Emergency Medicine / Q000191:economics* / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007118:Immunoassay / Q000191:economics / Q000379:methods; D007223:Infant; D007251:Influenza, Human / Q000175:diagnosis*; D008297:Male; D025202:Molecular Diagnostic Techniques / Q000191:economics* / Q000379:methods*; D060885:Multiplex Polymerase Chain Reaction / Q000191:economics* / Q000379:methods*; D013997:Time Factors