Evaluating Cost Savings of Adenoviral Conjunctivitis PCR Testing Among Employees

Diagnosing suspected cases of adenoviral conjunctivitis in a hospital setting with polymerase chain reaction (PCR) testing resulted in substantial savings compared with furloughing all who appear symptomatic, according to new study findings.

The quality improvement study, published in JAMA Ophthalmology, assessed Johns Hopkins Medicine (JHM) employees with red eye from 2011 to 2018. Of 1520 employees with red eye who underwent PCR testing, 130 (8.6%) had positive adenoviral results, of whom 41 (3.5%) had epidemic keratoconjunctivitis (EKC). The costs of furloughing only those who tested positive compared to sending home all symptomatic employees resulted in an annual savings of $442,000 annually, or $3.1 million over the 7-year span.

Acute conjunctivitis imposes serious health and economic burdens. Direct and indirect costs in the United States in 2005 ranged from $377 million to $857 million. Human adenoviruses are the most common cause of viral conjunctivitis. EKC is the most contagious version; it has forced the closure of clinics, hospitals, and other health care facilities. EKC can also cause chronic vision impairment from corneal scarring and dry eye.

JHM devised a “red eye” initiative to promote swift triage, accurate diagnosis, and prevention of transmitting the virus to patients and among employees. Nurse practitioners in occupational and environmental medicine were taught to diagnose suspected cases of adenoviral conjunctivitis and how to swab for it. Employees with PCR-confirmed cases were placed on a 2-week furlough initially. In 2014, the policy was modified to 1-week furloughs for those with non-EKC adenoviral conjunctivitis and 2 weeks for those with EKC.

PCR and viral culture are considered the gold standards for adenoviral conjunctivitis. Total nucleic acid is isolated from conjunctival specimens, with adenovirus DNA detected by real-time PCR, the authors explained .

Of 1520 employees, 1390 received negative PCR results who otherwise would have been furloughed. These individuals were thus able to return to work the next day, according to the study.

Without the policy, a 2-week furlough of 1520 employees—at a cost of $2278 per furlough—would have cost the institution $3.5 million over the 7-year span, the authors found. The savings were $3,094,511 over 7 years, or an average of $442,073 annually.

The cost of performing PCR was 5% of the cost of a 2-week furlough for all employees, the authors said. Significantly, no outbreaks of 4 weeks or more occurred.

“Institutions that adopt a similar policy may benefit from cost savings as a result of accurate diagnosis and reduction in the number of work furloughs while also preserving clinical operations and maintaining infection control,” the authors wrote.

To this point, however, there is no commercially available test for adenoviral conjunctivitis, the authors noted. There is a point-of-care antigen-based test that produces results in 10 to 15 minutes. But its reported sensitivity ranges from 33% (95% CI, 4%-78%) to 90% (no CI reported). As a result, subsequent PCR tests would be required for many employees with negative test results.

The policy also reduced unnecessary prescribing of antibiotics, which if overused can lead to ocular surface flora and antibiotic resistance, the authors said.

Reference

Kuo IC and Gower EW. Cost savings from a policy to diagnose and prevent transmission of adenoviral conjunctivitis in employees of a large academic medical center. JAMA Ophthalmol. Published online April 1, 2021. doi:10.1001/jamaophthalmol.2021.0150