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.

Keywords: COVID-19; SARS-CoV-2; antigen testing; cost–benefit analysis; point-of-care; real-time reverse transcriptase polymerase chain reaction (RT-PCR).

Figure 1

Point-of-Care antigen Testing (POCT) versus the conventional approach in COVID-19 suspects prior to hospitalization. Legend: a decision node (square) indicates a choice facing the decision-maker or the consequences of a decision. Branches from a chance node (circles) represent the possible outcomes of an event; terminal nodes (triangles) denote the endpoints of a scenario and are assigned in Table 2. Savanna_COVID_sens: sensitivity of Savanna^® Multiplex RT-PCR; Savanna_COVID_spec: specificity of Savanna^® Multiplex RT-PCR testing; Clin_sens_COVID: sensitivity of diagnosing SARS-CoV-2 infection; Clin_spec_COVID: probability of correctly excluding SARS-CoV-2. #: Complementary probability (all probabilities of chance node’s branches to sum to 1.0); +: positive; −: negative.

Figure 2

Tornado sensitivity analysis dashboard. The red and blue bars in the Tornado graph represent individual one-way sensitivity analysis performed for each variable. They include a vertical dotted line indicating the expected value (saving of €148.37) by utilizing the Savanna^®.