Determination of the relative economic impact of different molecular-based laboratory algorithms for respiratory viral pathogen detection, including Pandemic (H1N1), using a secure web based platform

Abstract

BackgroundDuring period of crisis, laboratory planners may be faced with a need to make operational and clinical decisions in the face of limited information. To avoid this dilemma, our laboratory utilizes a secure web based platform, Data Integration for Alberta Laboratories (DIAL) to make near real-time decisions.This manuscript utilizes the data collected by DIAL as well as laboratory test cost modeling to identify the relative economic impact of four proposed scenarios of testing for Pandemic H1N1 (2009) and other respiratory viral pathogens.MethodsHistorical data was collected from the two waves of the pandemic using DIAL. Four proposed molecular testing scenarios were generated: A) Luminex respiratory virus panel (RVP) first with/without US centers for Disease Control Influenza A Matrix gene assay (CDC-M), B) CDC-M first with/without RVP, C) RVP only, and D) CDC-M only. Relative cost estimates of different testing algorithm were generated from a review of historical costs in the lab and were based on 2009 Canadian dollars.ResultsScenarios A and B had similar costs when the rate of influenza A was low (< 10%) with higher relative cost in Scenario A with increasing incidence. Scenario A provided more information about mixed respiratory virus infection as compared with Scenario B.ConclusionsNo one approach is applicable to all conditions. Testing costs will vary depending on the test volume, prevalence of influenza A strains, as well as other circulating viruses and a more costly algorithm involving a combination of different tests may be chosen to ensure that tests results are returned to the clinician in a quicker manner. Costing should not be the only consideration for determination of laboratory algorithms.

Hospital admissions for lower respiratory tract infections among infants in the Canadian Arctic: a cohort study

“…When influenza A (H1N1) emerged, in April 2009, a real-time polymerase chain reaction assay for influenza A virus was implemented for all specimens. 18 Bacterial or fungal testing was ordered by the attending physician as clinically indicated. All positive results were recorded.…”

Use of an Innovative Web-Based Laboratory Surveillance Platform to Analyze Mixed Infections Between Human Metapneumovirus (hMPV) and Other Respiratory Viruses Circulating in Alberta (AB), Canada (2009–2012)

“…Specimens that were positive for influenza A were also subtyped for seasonal H3, seasonal H1 and pandemic H1N1 (2009) genes by RT-PCR. A cost effective approach was adopted in June 2009, to only test specimens negative for both influenza A and B by either singleplex or multiplex real time PCR assays using the Respiratory Virus Panel (RVP) classic assay, a multiplexed assay which detects multiple respiratory viral pathogens including FLUA, FLUB, PIV, ERV, ADV, 4 types of CRV, RSV, and hMPV [15]. Exceptions to this testing policy include samples submitted from a provincial influenza-like-illness surveillance program (Tarrant Viral Watch) and some samples from patients with severe illness and admission to the intensive care units.…”

Rethinking Approaches to Improve the Utilization of Nucleic Acid Amplification Tests for Detection and Characterization of Influenza A in Diagnostic and Reference Laboratories

“…Some work has been done on the economic impact of influenza RT-PCR testing and publications cite turn-around times as measurable statistics, and although some preliminary work suggests a patient benefit to early diagnosis and antiviral therapy [143,144], the impact of utilizing RT-PCR for influenza A to guide patient care and antibiotic/antiviral utilization has not been completely elucidated [145,146]. During and following future science group the influenza pandemic of 2009, several national organizations released guidelines and recommendations on molecular detection and characterization of the IFVA virus.…”