Cost–Benefit of Real-Time Multiplex PCR Testing of SARS-CoV-2 in German Hospitals

Abstract

Background: The current Omicron COVID-19 pandemic has significant morbidity worldwide. Objective: Assess the cost–benefit relation of implementing PCR point-of-care (POCT) COVID-19 testing in the emergency rooms (ERs) of German hospitals and in the case of inpatient admission due to other acute illnesses. Methods: A deterministic decision-analytic model simulated the incremental costs of using the Savanna® Multiplex RT-PCR test compared to using clinical judgement alone to confirm or exclude COVID-19 in adult patients in German ERs prior to hospitalization or just prior to discharge. Direct and indirect costs were evaluated from the hospital perspective. Nasal or nasopharyngeal swabs of patients suspected to have COVID-19 by clinical judgement, but without POCT, were sent to external labs for RT-PCR testing. Results: In probabilistic sensitivity analysis, assuming a COVID-19 prevalence ranging between 15.6–41.2% and a hospitalization rate between 4.3–64.3%, implementing the Savanna® test saved, on average, €107 as compared to applying the clinical-judgement-only strategy. A revenue loss of €735 can be avoided when SARS-CoV-2 infection in patients coming unplanned to the hospital due to other acute illnesses are excluded immediately by POCT. Conclusions: Using highly sensitive and specific PCR-POCT in patients suspected of COVID-19 infection at German ERs may significantly reduce hospital expenditures.

The Role and Value of Professional Rapid Testing of Acute Respiratory Infections (ARIs) in Europe: A Special Focus on the Czech Republic, Poland, and Romania

“…In low-resource countries, rapid antigen tests have shown to be a cost-effective strategy which has increased timely access to diagnosis, regardless of epidemic phase [ 219 , 220 , 221 ]. On the other hand, rapid molecular and multiplex tests, which in general are more expensive than RT-qPCR, show promising cost-effectiveness in studies undertaken in emergency rooms and hospital settings in high-resource countries [ 70 , 71 ]. Whatever the option, accurate diagnosis remains critical as effective treatments for COVID-19 have the potential to offer value for money to healthcare systems, people, and society [ 222 ].…”

“…Studies conducted during the emergency phase of the COVID-19 pandemic in hospital settings revealed that systematic screening using RT-qPCR tests of patients with respiratory symptoms can be an effective but highly resource-intensive containment strategy, unlikely to be sustained in the long run [ 69 ]. Nevertheless, as new rapid molecular testing technologies have become available, studies from high-resource countries, such as Germany, have shown promising results on the cost-effectiveness of such methods in emergency rooms and hospital settings [ 70 , 71 ]. Similarly, studies in Germany and Italy have also found economic benefits when using rapid antigen tests [ 72 , 73 ].…”

Differential Diagnosis in the Management of Acute Respiratory Infections through Point-of-Care Rapid Testing in a Post-Pandemic Scenario in Latin America: Special Focus on COVID-19, Influenza, and Respiratory Syncytial Virus

“…In this context, diagnostic tests are more likely to be cost-effective if they can provide accurate results quickly [220]. While clinical evidence on the cost-effectiveness of POC testing for COVID-19 is limited and immature [220], even studies using high-cost methods, such as rapid molecular tests, show considerable cost-saving benefits down the line [208,209]. For example, a study found that the use of rapid COVID-19 molecular testing in an emergency department and shock room led to a reduction of USD 285.23 in direct costs in admissions with subsequent surgery, and USD 79.02 without surgery [208].…”

“…This is particularly important as new rapid molecular testing technologies become available. While rapid molecular testing is in general more expensive than RT-qPCR, studies from high-resource countries have shown promising results on the cost-effectiveness of such methods in emergency rooms and hospital settings [208,209].…”