A cost-consequence analysis of the Xpert Xpress CoV-2/Flu/RSV plus test strategy for the diagnosis of influenza-like illnesses

Abstract

Aims

Influenza-like illnesses (ILI) affect millions each year in the United States (US). Determining definitively the cause of symptoms is important for patient management. Xpert Xpress CoV-2/Flu/RSV plus (Xpert Xpress) is a rapid, point-of-care (POC), multiplex real-time polymerase chain reaction (RT-PCR) test intended for the simultaneous qualitative detection and differentiation of SARS-CoV-2, influenza A/B, and respiratory syncytial virus (RSV). The objective of our analysis was to develop a cost-consequence model (CCM) demonstrating the clinico-economic impacts of implementing PCR testing with Xpert Xpress compared to current testing strategies.

Methods

A decision tree model, with a 1-year time horizon, was used to compare testing with Xpert Xpress alone to antigen POC testing and send-out PCR strategies in the US outpatient setting from a payer perspective. A hypothetical cohort of 1,000,000 members was modeled, a portion of whom develop symptomatic ILIs and present to an outpatient care facility. Our main outcome measure is cost per correct treatment course.

Results

The total cost per correct treatment course was $1,131 for the Xpert Xpress strategy compared with a range of $3,560 to $5,449 in comparators. POC antigen testing strategies cost more, on average, than PCR strategies.

Limitations

Simplifying model assumptions were used to allow for modeling ease. In clinical practice, treatment options, costs, and diagnostic test sensitivity and specificity may differ from what is included in the model. Additionally, the most recent incidence and prevalence data was used within the model, which is not reflective of historical averages due to the SARS-CoV-2 pandemic.

Conclusion

The Xpert Xpress CoV-2/Flu/RSV plus test allows for rapid and accurate diagnostic results, leading to reductions in testing costs and downstream healthcare resource utilization compared to other testing strategies. Compared to POC antigen testing strategies, PCR strategies were more efficient due to improved diagnostic accuracy and reduced use of confirmatory testing.

Keywords:

• Influenza-like illness
• diagnostics
• PCR
• costs
• cost-consequence

JEL CLASSIFICATION CODES:

• I10
• I1
• I
• I19

Declaration of funding

Financial support for this study was provided by Cepheid (CA, United States). The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report. The content and results in this manuscript were approved by all authors and has not been subject to sponsor censorship.

Declaration of financial/other relationships

SD, EB, IJ, and CM are employees of PRECISIONheor, which provides consulting services to the diagnostic and pharmaceutical industries, including Cepheid. AB and JC are employed by Cepheid.

Author contributions

All authors contributed to the conception and design of the study, data acquisition and analysis, and interpretations of the results. EB and SD drafted the first draft of the manuscript. All authors critically revised the manuscript to its final stages, approved the final version of the manuscript, and take responsibility for all aspects of the study.

Acknowledgements

No assistance in the preparation of this article is to be declared.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.