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Rapid Molecular Detection and Differentiation of Influenza Viruses A and B
Published on: January 30, 2017
Use of clinical algorithms and rapid influenza testing to manage influenza-like illness: a cost-effectiveness
L Gayani Tillekeratne1,2, Champica Bodinayake3, Ajith Nagahawatte3
1School of Medicine, Duke University, Durham, North Carolina, USA.
Background:
Acute respiratory infections are a common reason for antibiotic overuse. We previously showed that providing Sri Lankan clinicians with positive rapid influenza test results was associated with a reduction in antibiotic prescriptions. The economic impact of influenza diagnostic strategies is unknown.
Methods:
We estimated the incremental cost per antibiotic prescription avoided with three diagnostic strategies versus standard care when managing Sri Lankan outpatients with influenza-like illness (ILI): (1) influenza clinical prediction tool, (2) targeted rapid influenza testing and (3) universal rapid influenza testing. We compared findings with literature-based estimates of the cost of antimicrobial resistance attributable to each antibiotic prescription.
Results:
Standard care was less expensive than other strategies across all parameter values in one-way sensitivity analyses. The incremental cost per antibiotic prescription avoided with clinical prediction versus standard care was US$3.0, which was lower than the base-case estimate of the cost of antimicrobial resistance per ILI antibiotic prescription (US$12.5). The incremental cost per antibiotic prescription avoided with targeted testing and universal testing versus standard care were both higher than the base-case cost of antimicrobial resistance per ILI antibiotic prescription: US$49.1 and US$138.3, respectively. To obtain a cost-effectiveness ratio lower than US$12.5 with targeted testing versus standard care, the test price must be
Conclusion:
Clinical prediction tools and targeted rapid influenza testing may be cost-saving strategies in Sri Lanka when accounting for the societal cost of antimicrobial resistance.
Insights
In Sri Lanka, clinical prediction tools and targeted rapid influenza testing can reduce antibiotic prescriptions for influenza-like illness (ILI). These strategies may be cost-saving when considering the societal cost of antimicrobial resistance.
Area of Science:
- Health Economics
- Infectious Disease Management
- Antimicrobial Stewardship
Background:
- Acute respiratory infections frequently lead to antibiotic overuse.
- Previous research indicated that providing rapid influenza test results reduced antibiotic prescriptions among Sri Lankan clinicians.
- The economic implications of various influenza diagnostic approaches remained undetermined.
Purpose of the Study:
- To evaluate the cost-effectiveness of different influenza diagnostic strategies in managing outpatients with influenza-like illness (ILI) in Sri Lanka.
- To compare the cost per antibiotic prescription avoided for clinical prediction tools, targeted rapid influenza testing, and universal rapid influenza testing against standard care.
- To assess these costs in relation to the economic burden of antimicrobial resistance.
Main Methods:
- Cost-effectiveness analysis comparing three strategies (clinical prediction tool, targeted testing, universal testing) with standard care for ILI management.
- Calculation of incremental cost per antibiotic prescription avoided.
- Comparison with literature-based estimates of antimicrobial resistance costs per prescription.
Main Results:
- Standard care was the least expensive strategy across sensitivity analyses.
- Clinical prediction tools demonstrated an incremental cost of US$3.0 per antibiotic prescription avoided, below the estimated antimicrobial resistance cost of US$12.5.
- Targeted and universal rapid influenza testing incurred higher costs per avoided prescription (US$49.1 and US$138.3, respectively), with specific test price thresholds for cost-effectiveness.
Conclusions:
- Clinical prediction tools represent a potentially cost-saving strategy for ILI management in Sri Lanka.
- Targeted rapid influenza testing can be cost-saving if test prices are sufficiently low (
- Both strategies, when factoring in the societal cost of antimicrobial resistance, offer economic benefits.
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