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Commercial PCR flu test reduces cost, waiting time for patients
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Use of a rapid commercial PCR assay helped to reduce the mean waiting and isolation times of patients in the ED and reduced costs per patient compared with an in-house PCR assay, according to researchers from Spain.
“Prior to 2014, specimens were tested for influenza using an in-house real-time PCR assay that required 4 hours of technical expertise; as such, it was only carried out during working hours … thereby delaying the time of result delivery,” Marcelo Soto, PhD, from the Fundació Clínic per a la Recerca Biomèdica in Barcelona, and colleagues wrote. “This, in turn, affected the time to discharge of ED patients and unnecessarily increased the isolation time for hospitalized patients.”
However, the Xpert Flu assay (Cepheid), an automated real-time PCR test for in vitro detection of influenza A, influenza B and the H1N1pdm09 subtype, produces results in 70 minutes, according to the researchers.
To compare costs of the standard in-house PCR and Xpert Flu assay, Soto and colleagues recruited adult patients over two time periods: a control group of 366 patients who were tested for influenza between January and March 2013 in the Hospital Clinic of Barcelona using the in-house PCR only, and a treatment group of 691 patients prospectively recruited at the same facility between January and March 2014 who were tested using both systems. There were no significant differences between the groups regarding age, influenza prevalence rate by year or mean number of risk factors, according to the researchers. Hospitalized patients were included in the analysis.
Costs were evaluated from the perspective of the hospital and were directly related to influenza testing, the researchers said.
Of the 691 samples processed by the in-house PCR and Xpert Flu in 2014, 27% of specimens were positive by both methods, 72% were negative, and 0.9% samples were discordant. According to the researchers, the Kappa agreement coefficient was 97.8%.
Soto and colleagues found that the Xpert Flu assay reduced waiting times for ED patients by 9.1 hours (95% CI, –14.7 to –3.5) compared with the in-house PCR, while hospitalized patients had their mean waiting time reduced by 23.7 hours using the commercial assay. Furthermore, the hospital saved €103, or approximately $113, per patient by administering the commercial assay in the ED and €64, or $70, per patient within the hospital.
“Savings associated with Xpert Flu were almost fully explained by the shorter time spent in the ED examination room,” Soto and colleagues wrote. “Savings in unnecessary isolation of negative patients (disposables and nursing) explain the difference.” – by Jeff Craven
Disclosure: The researchers report no relevant financial disclosures.
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