Is the repeat worth it? Optimizing syndromic panel pathogen detection protocols

Filipe M Cerqueira; Linh Do; Janet Enderle; Ping Ren

doi:10.1093/labmed/lmae100

Is the repeat worth it? Optimizing syndromic panel pathogen detection protocols

Lab Med. 2024 Dec 17:lmae100. doi: 10.1093/labmed/lmae100. Online ahead of print.

Authors

Filipe M Cerqueira¹, Linh Do², Janet Enderle², Ping Ren¹

Affiliations

¹ Department of Pathology, School of Health Professions, University of Texas Medical Branch, Galveston, TX, US.
² Department of Clinical Laboratory Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX, US.

PMID: 39688504
DOI: 10.1093/labmed/lmae100

Abstract

Objective: The aim of the study was to compare the cost and clinical impact of repeating BioFire FilmArray gastrointestinal (GI) and respiratory (RP) panel assays with 3 vs 4 pathogen targets positive.

Method: We analyzed 12,027 GI and RP panels to evaluate our retesting policy, which retested panels with 3 or more detected pathogens (3-pathogen protocol) compared with the manufacturer's 4-pathogen (4-pathogen protocol) recommendation. We compared the retesting results, calculated the cost implications, and reviewed the clinical impact on antibiotic prescriptions and patient outcomes.

Results: Retesting with our 3-pathogen protocol revealed that 81% (39/48) of GI and 76% (26/34) of RP panels had identical results, whereas 19% (9/48) of GI and 24% (8/34) of RP panels showed discrepancies on retesting. The additional cost incurred by our protocol compared with the manufacturer's protocol was $9820.32. There was no evidence that our more stringent policy affected antibiotic prescription or clinical outcomes.

Conclusion: Our more stringent 3-pathogen protocol for retesting panels did not improve patient management compared with the manufacturer's 4-pathogen protocol but resulted in unnecessary costs and increased the risk of depleting testing kits during supply shortages. Consequently, we adopted the manufacturer's suggestions, highlighting the need to balance clinical rigor with cost-effectiveness in laboratory testing protocols.

Keywords: cost analysis; gastrointestinal panel; laboratory testing; molecular diagnostics; repeat testing; respiratory panel.

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