Clinical Impact, Costs, and Cost-effectiveness of Expanded Severe Acute Respiratory Syndrome Coronavirus 2 Testing in Massachusetts

Abstract

Background We projected the clinical and economic impact of alternative testing strategies on COVID-19 incidence and mortality in Massachusetts using a microsimulation model. Methods We compared four testing strategies: 1) Hospitalized: PCR testing only patients with severe/critical symptoms warranting hospitalization; 2) Symptomatic: PCR for any COVID-19-consistent symptoms, with self-isolation if positive; 3) Symptomatic+asymptomatic-once: Symptomatic and one-time PCR for the entire population; and, 4) Symptomatic+asymptomatic-monthly: Symptomatic with monthly re-testing for the entire population. We examined effective reproduction numbers (Re, 0.9-2.0) at which policy conclusions would change. We assumed homogeneous mixing among the Massachusetts population (excluding those residing in long-term care facilities). We used published data on disease progression and mortality, transmission, PCR sensitivity/specificity (70/100%) and costs. Model-projected outcomes included infections, deaths, tests performed, hospital-days, and costs over 180-days, as well as incremental cost-effectiveness ratios (ICER, $/quality-adjusted life-year [QALY]). Results At Re 0.9, Symptomatic+asymptomatic-monthly vs. Hospitalized resulted in a 64% reduction in infections and a 46% reduction in deaths, but required >66-fold more tests/day with 5-fold higher costs. Symptomatic+asymptomatic-monthly had an ICER <$100,000/QALY only when Re ≥1.6; when test cost was ≤$3, every 14-day testing was cost-effective at all Re examined. Conclusions Testing people with any COVID-19-consistent symptoms would be cost-saving compared to testing only those whose symptoms warrant hospital care. Expanding PCR testing to asymptomatic people would decrease infections, deaths, and hospitalizations. Despite modest sensitivity, low-cost, repeat screening of the entire population could be cost-effective in all epidemic settings.

Clinical outcomes and cost-effectiveness of COVID-19 vaccination in South Africa

“…We previously used the CEACOV model to project COVID-19 clinical and economic outcomes in a variety of settings, including an analysis of non-pharmaceutical public health interventions in South Africa. [16][17][18][19] In this analysis, we focus on vaccination programs in South Africa and examine different implementation strategies and different vaccine characteristic and epidemic growth scenarios, thereby projecting which have the greatest impact on clinical and economic outcomes and cost-effectiveness.…”

The Main Molecular and Serological Methods for Diagnosing COVID-19: An Overview Based on the Literature

“…Even with the high cost associated with using the RT-PCR technique, Neilan et al [ 135 ] observed that individual testing of people with any symptoms consistent with COVID-19 could save costs compared to testing only on individuals whose symptoms justify hospital care. The study also shows that expanding RT-PCR testing to asymptomatic individuals could decrease infections, deaths and hospitalizations, which could be cost-effective in all epidemic scenarios [ 135 ]. However, mass testing using the RT-PCR technique can be a major challenge for populous countries, especially those with few financial resources.…”

Cost-effectiveness of COVID-19 vaccination in low- and middle-income countries

“…The Clinical and Economic Analysis of COVID-19 interventions (CEACOV) model is a validated, dynamic microsimulation of the natural history of COVID-19 and the impact of public health interventions 8,[25][26][27] . We used the CEACOV model to project the clinical impact, cost, and cost-effectiveness of donor outlays to purchase, distribute, and deploy SARS-CoV-2 vaccines to 91 low-and middle-income countries (LMICs).…”

“…We used the Clinical and Economic Analysis of COVID-19 interventions (CEACOV) model, a validated, dynamic microsimulation of the natural history of COVID-19 8,[25][26][27] (Supplementary Methods and Supplementary Fig. 1).…”