Cost effects of using point-of-care multiplex PCR for high consequence infectious diseases suspect cases

High-consequence infectious diseases (HCID) are rare in Europe but require rapid evaluation due to the risk of transmission. Suspected cases often involve resource-intensive high-level isolation. Point-of-care multiplex PCR may shorten unnecessary isolation by enabling faster rule-out.

We developed a decision-analytic model comparing the BioFire^® FilmArray^® Global Fever Panel (RUO) plus standard diagnostics (strategy 1) versus standard diagnostics alone (strategy 2). Costs were assessed from the hospital perspective from blood sampling to the standard diagnostic result, plus contact isolation after unprotected exposure following false-negative multiplex results. Two scenarios were analysed separately: the patient is HCID infected vs. not infected. We performed a base case deterministic analysis using the baseline parameter values and a probabilistic sensitivity analysis (PSA; 10,000 simulations).

In the base case deterministic analysis, strategy 1 increased costs by € 406.35 per infected patient and reduced costs by € 2,009.31 per non-infected patient compared to strategy 2. Concerning the PSA, strategy 1 remained more costly for infected patients (mean Δ_inf € 408.75; range € 207.4 - € 1,083.9) and cost-saving for non-infected patients (mean Δ_not € 2,098.40; range € 1,097.0 - € 3,371.9). Key drivers were multiplex sensitivity (infected scenario) and isolation costs during standard diagnostics and the multiplex pcr (non-infected scenario).

Multiplex PCR increased costs in true HCID cases but reduced costs in non-infected suspects by shortening isolation. Given the very low frequency of true HCID among suspected cases in Europe, overall cost savings appear plausible, depending on local workflows and isolation costs.