LumiraDx Cost effectiveness

Recent studies have shown substantial cost savings have been related to the successful implementation of POC testing in different settings, and that the majority of POC testing-related savings are found downstream in the process of patient care.¹

Improving patient outcomes doesn’t have to come with a cost premium. At LumiraDx, we are focused on optimising the patient experience, and published data would suggest that this can also significantly reduce overall healthcare spend.

CRP in primary care

At present, rapid diagnostic tools are not widely utilized or effectively integrated into pathways, representing a significant area for reform and innovation in practice that could progress the AMR (Antimicrobial Resistance) agenda.²

The majority of unnecessary antibiotics are prescribed in primary care for community-acquired respiratory diseases^2,3 and statistics indicate that up to 90% of RTIs (respiratory tract infections) are caused by viruses.⁴ However, despite evidence showing patients will get little or no benefit from antibiotics, nearly 80% of patients consulting for this condition are prescribed them.^4,5

Diagnostic uncertainty plus patient expectations and concerns continue to drive unnecessary prescribing.⁶

CRP offers clinicians a rapid test to guide antibiotic prescribing decisions.⁷

Using a POC CRP test in primary care has been shown to reduce antibiotic prescribing by 23-36% for RTIs⁸ and 22% for COPD (chronic obstructive pulmonary disease).⁹

CRP in primary care

Diagnostic uncertainty plus patient expectations and concerns continue to drive unnecessary prescribing.⁶

CRP offers clinicians a rapid test to guide antibiotic prescribing decisions.⁷

Using a POC CRP test in primary care has been shown to reduce antibiotic prescribing by 23-36% for RTIs⁸ and 22% for COPD (chronic obstructive pulmonary disease).⁹

Cost savings based on implementing POC CRP based strategies compared to traditional clinical pathways of up to €7.94.¹⁰

CRP in community-based settings

CRP testing in the community can support real-time decision-making on the need for antibiotic treatment in frail, acutely unwell patients. This supports the avoidance of hospital admission, rather than waiting for lab results several hours later POC CRP can inform immediate treatment change.

CRP in community-based settings

In a case study by Frimley Health, as part of a Hospital at Home service, point of care testing for CRP improved the safety of care and helped avoid the need for escalation to hospital, at a cost of up to €4,545 per patient in 50% of the patients assessed.¹¹

Similarly, in a case study by Frimley Health, POC CRP improved the safety of care and helped avoid the need for escalation to hospital care in 50% of the patients assessed.¹¹

NT-proBNP in primary care & community-based settings

Heart failure (HF) is a leading cause of patient morbidity, disability, mortality and health inequality globally.

Diagnosis of HF via the hospital admission-based pathway continues to dominate.¹² This pathway is associated with a significantly greater short-term risk of mortality and substantially increased long-term costs, compared to being diagnosed in the community.¹³

HF diagnosis via the hospital-based pathway, which typically occurs after patients have started experiencing severe symptoms, is estimated to incur an overall extra cost of €2,877 per patient.¹³

Ruling out HF in primary care can reduce referrals to specialists and the requirement for more advanced diagnostic interventions by 25%.¹⁴

NT-proBNP in primary care & community-based settings

Heart failure (HF) is a leading cause of patient morbidity, disability, mortality and health inequality globally.

HF diagnosis via the hospital-based pathway, which typically occurs after patients have started experiencing severe symptoms, is estimated to incur an overall extra cost of £2,485 per patient.¹³

Ruling out HF in primary care can reduce referrals to specialists and the requirement for more advanced diagnostic interventions by 25%.¹⁴

D-Dimer in primary care & community-based settings

Traditional pathways for the diagnosis of VTE (venous thromboembolism) involve multiple points of contact, and eventual diagnosis can take hours, or even days to achieve.¹⁵

POC D-Dimer testing is used as an aid in the diagnosis of venous thromboembolism (VTE) and is widely accepted as the first step in the management of patients with suspected VTE.¹⁶ A D-Dimer result can exclude patients from the VTE pathway in conjunction with a low-risk clinical pre-test probability score.¹⁵

Using point of care testing for D-Dimer as part of a strategy to exclude DVT in primary care has been found to be cost effective compared to secondary care-based strategies.¹⁷

D-Dimer in primary care & community-based settings

Traditional pathways for the diagnosis of VTE (venous thromboembolism) involve multiple points of contact, and eventual diagnosis can take hours, or even days to achieve.¹⁵

Using point of care testing for D-Dimer as part of a strategy to exclude DVT in primary care has been found to be cost effective compared to secondary care-based strategies.¹⁷

Cost savings based on implementing POC D-Dimer based strategies compared to laboratory testing could be between €87 and €103 per patient.¹⁸

For a hub and spoke model, this could save up to €36,050 per year based on 350 patients presenting.¹⁸

References
1. Schilling UM. The economic benefits of point-of-care testing. Hospital Healthcare Europe, special supplement. www.hospitalhealthcare.com
2. Testing Times Final Report on the role of rapid diagnostics in tackling antimicrobial resistance (AMR). 2022. In partnership with British In Vitro Diagnostic Association (BIVDA). https://form.lumiradx.com/white-papers/testing-times/
3. O’Neill, J. Tackling Drug-Resistant Infections Globally: Final Report and Recommendations. 2016.
4. Van der Velden AW, et al. Point-of-care testing, antibiotic prescribing, and prescribing confidence for respiratory tract infections in primary care: a prospective audit in 18 European countries. BJGP Open. 2022.
5. Bjerrum, L., Munck, A., Gahrn-Hansen, B. et al. Health Alliance for Prudent Prescribing, Yield and Use of Antimicrobial Drugs in the Treatment of Respiratory Tract Infections (HAPPY AUDIT). BMC Fam Pract. 2010.
6. Hopstaken R et al. Do clinical findings in lower respiratory tract infection help general practitioners prescribe antibiotics appropriately? An observational cohort study in general practice; Family Practice. 2006.
7. Online article. ‘GPs feel pressurised to prescribe unnecessary antibiotics, survey finds.’ BMJ 2014;349:g5238
8. Cooke, J. et al. (2015) ‘Narrative review of primary care point-of-care testing (POCT) and antibacterial use in respiratory tract infection (RTI)’, BMJ Open Respiratory Research, 2(1). doi:10.1136/bmjresp-2015-000086
9. Butler CC, Gillespie D, White P, et al. C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations. N Engl J Med. 2019;381(2):111-120. doi:10.1056/NEJMoa1803185
10. Hunter, R. Cost-Effectiveness of Point-of-Care C-Reactive Protein Tests for Respiratory Tract Infection in Primary Care in England. Advances in therapy. 2015. 32 (1); 69-85
11. Riddoch et al. Clinical Impact of POCT CRP testing in the Hospital@Home service. (2023) Frimley Health NHS Foundation Trust Poster
12. NHS England Guideline. Enhancing GP direct access to diagnostic tests for patients with suspected chronic obstructive pulmonary disease, asthma, or heart failure. 2024
13. Bachtiger P, et.al. Survival and health economic outcomes in heart failure diagnosed at hospital admission versus community settings: a propensity-matched analysis. BMJ Health & Care Informatics. 2023
14. Bayes-Genis A, Rosana G. Unlocking the potential of natriuretic peptide testing in primary care: a roadmap for early heart failure diagnosis. European Journal of Heart Failure. 2023.
15. Kearon C. Diagnosis of suspected venous thromboembolism. Hematology Am Soc Hematol Educ Program. 2016 Dec 2;2016(1):397-403. doi: 10.1182/asheducation-2016.1.397. PMID: 27913507; PMCID: PMC6142443.
16. Rodger MA, Le Gal G, Wells P et al. Clinical decision rules and D-Dimer in venous thromboembolism: current controversies and future research priorities. Throm Res 2014; 134,4: 763-68
17. Price CP, Fay M, Hopstaken RM. Point-of-Care Testing for D-Dimer in the Diagnosis of Venous Thromboembolism in Primary Care: A Narrative Review. Cardiol Ther. 2021 Jun;10(1):27-40. doi: 10.1007/s40119-020-00206-2. Epub 2020 Dec 2. PMID: 33263839; PMCID: PMC8126530.
18. Heerink J.S., et al. Two point-of-care test-based approaches for the exclusion of deep vein thrombosis in general practice: a cost-effectiveness analysis. BMC Primary Care (2023) 24:42. https://doi.org/10.1186/s12875-023-01992-z