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Int J Environ Res Public Health. 2019 Jul 3;16(13). pii: E2368. doi: 10.3390/ijerph16132368.

Cost-Benefit Analysis of Real-Time Influenza Testing for Patients in German Emergency Rooms.

Diel R1,2,3, Nienhaus A4,5.

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Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, Kiel, Airway Research Center North (ARCN), 24015 Kiel, Germany.
Lung Clinic Grosshansdorf, Germany. Airway Disease Center North (ARCN), German Center for Lung Research (DZL), 22949 Großhansdorf, Germany.
Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), 22089 Hamburg, Germany.
Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), 22089 Hamburg, Germany.
Institute for Health Service Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.



Seasonal influenza causes significant morbidity worldwide and has a substantial economic impact on the healthcare system.


To assess the cost-benefit relation of implementing a real-time influenza test in emergency rooms (ER) of German hospitals.


A deterministic decision-analytic model was developed simulating the incremental costs of using the Solana® Influenza A+B test, compared to those of using conventional clinical judgement alone to confirm or exclude influenza in adult ILI (influenza-like illness) patients, in German ER, prior to hospitalization. Direct costs were evaluated from the hospital perspective, considering resource use directly related to influenza testing and treatment, as well as indirect costs incurred by nosocomial influenza transmission.


Through base-case analysis and assuming an influenza prevalence of 42.6%, real-time testing with Solana® reduced average costs of hospitalized ILI patients by €132.61, per tested patient. Moreover, the Solana® saved €6.9 per tested patient in favor of the hospital. In probabilistic sensitivity analysis, under all reasonable assumptions, implementing the Solana® saved on average €144.13 as compared to applying the clinical-judgement-only strategy, thus, it was found to be constantly less expensive.


Using highly sensitive and specific real-time influenza tests in ILI patients at German ER might significantly reduce hospital expenditures.


PCR; cost–benefit analysis; influenza; real-time testing; sensitivity analysis

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