Cost-effectiveness analysis of COVID-19 tests in the unified health system

Abstract

Background To evaluate the cost-effectiveness ratio and economic impact of the Rapid Antigen Test (TR-Ag) to replace RT-PCR for the detection of the new Coronavirus in the Unified Health System (SUS). Methods This is a cost-effectiveness analysis. Clinical protocols were used for the diagnosis of COVID-19 at the São José Municipal Hospital, located in the city of Itaberá-SP. The Incremental Cost-Effectiveness Ratio (ICER) was divided into two scenarios. In the first, the accuracy reported by the test manufacturers was included, and in the second, the cost resulting from a systematic review. Both were compared with the performance of the RT-PCR test. The increase in diagnoses was chosen as a health outcome and absenteeism was used as a criterion for assessing the economic impact. Results The analysis resulted in incremental cost-effectiveness ratios of R$ 42,136.67 and R$ 68,329.73 for every thousand tests, according to the accuracy of the manufacturers’ TR-Ag tests and what is reported in the literature in relation to RT-PCR, respectively. The average value found for the RT-PCR test (R$ 202.87) represents an increase of 165.32% in cost in relation to the value found for the TR-Ag. 4,305 tests were performed between April 2020 and December 2021 at the referral hospital. Also, maintaining the use of RT-PCR as the first choice for diagnosing COVID-19 and regulating absenteeism in the economically active population could have an impact of up to R$ 1,022,779.68 on municipal management. Conclusion It is concluded that the TR-Ag are configured as a cost-effective alternative for the SUS in the detection of the new Coronavirus. The strategy becomes economically favorable for the expansion of testing, combating the COVID-19 pandemic and reducing the impact on the local economy. However, studies are needed to validate the accuracy of the tests so that economic evaluations on the subject are more assertive.

The Role and Value of Professional Rapid Testing of Acute Respiratory Infections (ARIs) in Europe: A Special Focus on the Czech Republic, Poland, and Romania

“…This is particularly important as new rapid molecular and multiplex technologies become available. In low-resource countries, rapid antigen tests have shown to be a cost-effective strategy which has increased timely access to diagnosis, regardless of epidemic phase [ 219 , 220 , 221 ]. On the other hand, rapid molecular and multiplex tests, which in general are more expensive than RT-qPCR, show promising cost-effectiveness in studies undertaken in emergency rooms and hospital settings in high-resource countries [ 70 , 71 ].…”

Differential Diagnosis in the Management of Acute Respiratory Infections through Point-of-Care Rapid Testing in a Post-Pandemic Scenario in Latin America: Special Focus on COVID-19, Influenza, and Respiratory Syncytial Virus

“…The study found that, regardless of the epidemic phase, all countries sampled had insufficient molecular testing capacity to meet the calculated required testing demand within a relevant clinical time (48 h turnaround time) [201]. Furthermore, two studies in Brazil evaluating the replacement of RT-qPCR with Ag-RDTs found that they profile as a cost-effective alternative for the expansion of testing, combating COVID-19, and reducing the impact on the local economy [202,203]. One of these studies found a reduction in the total cost per patient of between USD 130.43 to USD 166.97 and unwanted clinical outcomes (avoiding 2406 to 3208 new cases of COVID-19, 457 to 609 hospitalizations, and 172 to 230 deaths per 38,000 antigen tests performed) [203].…”

“…One of these studies found a reduction in the total cost per patient of between USD 130.43 to USD 166.97 and unwanted clinical outcomes (avoiding 2406 to 3208 new cases of COVID-19, 457 to 609 hospitalizations, and 172 to 230 deaths per 38,000 antigen tests performed) [203]. Moreover, maintaining the use of RT-qPCR as the first choice for diagnosing COVID-19 in working-age patients was found to potentially lead to an additional USD 207,515.14 in management costs in the municipality of Itaberá [202].…”

“…However, additional cost-effectiveness studies are needed to validate the accuracy of the tests as part of such economic evaluations [202] and the role treatment pathways have on potential benefits based on actual practice [206]. Ultimately cost-effectiveness information on POC rapid testing should be used alongside other considerations, such as budget impact and feasibility, as part of a transparent decision-making process [207].…”