Impact of a novel community testing pathway for people with suspected COVID-19 in Wales: a cost-minimisation analysis

Abstract

ObjectiveTo compare National Health Service (NHS) organisations’ testing pathways for patients with suspected COVID-19 in the community versus standard hospital testing practices.PerspectiveNHS commissioners and services.MethodsDuring the containment phase of the COVID-19 pandemic we developed a community model pathway for COVID-19 testing in Wales with testing teams undertaking swabbing for COVID-19 in individuals’ usual place of residence. We undertook a cost-minimisation analysis comparing the costs to the NHS in Wales of community testing for COVID-19 versus standard hospital testing practices and ambulance conveyancing. We analysed data from patients with suspected COVID-19 between January and February 2020 and applied assumptions of costs from national contractual and reference costs for ambulances, staffing and transportation with market costs at the time of publication.Results177 patients with suspected COVID-19 underwent community testing via local NHS organisations between January and February 2020 with a mean age of 46.1 (IQR 27.5–56.3). This was 92% of total patients who were tested for COVID-19 during this period. We estimate, compared with standard hospital testing practices, cash savings in improved productivity for the NHS of £24,539 during this time period, in addition to further non-monetised benefits for hospital and ambulance flow.ConclusionsCommunity testing for COVID-19 in Wales is now an established pathway and continues to bring benefits for patients, local healthcare organisations and the NHS. Further application of this model in other settings and to other infectious diseases may herald promising returns.

Mitigating SARS-CoV-2 Transmission in Hispanic and Latino Communities—Prince William Health District, Virginia, June 2020

“…Poor access to SARS-CoV-2 testing was noted by many investigation participants. In addition to providing local testing site information in Spanish, other jurisdictions have reached underserved communities by sending testing teams to neighborhoods at risk, particularly outside of normal business hours [27,28]. People who are undocumented may also worry that accessing governmental SARS-CoV-2 testing may adversely affect their legal status, so it is important to explicitly emphasize patient confidentiality and any identification requirements for testing [29].…”

The economics of the COVID-19 pandemic: economic evaluation of government mitigation and suppression policies, health system innovations, and models of care

“… 2 13 Europe (Gandjour 2021 ) 1 7 UK (Currie et al 2020 ; Zala et al 2020 ; Miles et al 2021 ) 3 20 Africa (Reddy et al 2021 ; Cleary et al 2021 ) 2 13 Low- and Middle-Income Countries (LMIC)139 LMICs in East Asia and Pacific, Europe and Central Asia, Latin America and Caribbean, Middle East and North Africa, South Asia, and sub-Saharan Africa (SSA) (Risko et al 2020 ) 1 7 Economic evaluation study type Cost-utility analysis (Shaker et al 2020 ; Sheinson et al 2021 ; Jiang et al 2021 , 2020 ; Cleary et al 2021 ; Zala et al 2020 ) 6 40 Cost-effectiveness analysis (Baggett et al 2020 ; Reddy et al 2021 ; Savitsky and Albright 2020 ; Risko et al 2020 ; Du et al 2021 ; Gandjour 2021 ). 6 40 Cost-benefit analysis (Miles et al 2021 ; Broughel and Kotrous 2021 ) 2 13 Cost-minimisation analysis (Currie et al 2020 ) 1 7 Study design – model for estimation Decision tree & simulation model (Baggett et al 2020 …”

“… 6 40 Cost-benefit analysis (Miles et al 2021 ; Broughel and Kotrous 2021 ) 2 13 Cost-minimisation analysis (Currie et al 2020 ) 1 7 Study design – model for estimation Decision tree & simulation model (Baggett et al 2020 ; Savitsky and Albright 2020 ; Cleary et al 2021 ; Gandjour 2021 ). 4 27 Decision tree & Markov (Shaker et al 2020 ; Sheinson et al 2021 ; Jiang et al 2021 ) 3 20 Simulation model, e.g., Monte Carlo simulation (Reddy et al 2021 ; Risko et al 2020 ) 2 13 Patient simulation model (SEIR) with attached costs (Jiang et al 2020 ; Zala et al 2020 ) 2 13 Micro costing (Currie et al 2020 ) 1 7 Multi-scale model, stochastic individual based chain binomial (Du et al 2021 ) 1 7 CBA Macro costing using QALY (Miles et al 2021 ) 1 7 CBA Value of Production (Broughel and Kotrous 2021 ) 1 7 Perspective Societal & health car...…”

The cost of the COVID-19 pandemic vs the cost-effectiveness of mitigation strategies in the EU/UK/EEA and OECD countries: a systematic review

“…Concerning study characteristics, thirteen out of 31 studies were from the USA (25, 26, 36, 38, 40, 41, 44–46, 48, 50, 52, 54), seven from the UK (30-33, 42, 49, 53), three from Germany (28, 51, 55), one from Switzerland (47), Israel (34), and Wales (37), while five of these studies included analyses for multiple OECD countries (27, 29, 35, 39, 43). The societal perspective was followed in 14 studies (26, 28, 30, 31, 33, 34, 36, 39, 41, 43, 51, 52, 54, 55), while 9 studies performed an analysis via a healthcare perspective (25, 27, 37, 38, 40, 42, 46, 47, 49, 53). Various perspectives were included in 4 studies (44, 45, 48, 50), including the payer for some of them (45, 48, 50), while the perspective considered was unclear in three studies (29, 32, 35).…”

“…. A cost-minimization analysis performed by Currie et al (2020) (37) comparing community testing undertaking swabbing of suspected cases in Wales with standard hospital testing showed that community testing for COVID-19 was a superior strategy, resulting in significant benefits for the healthcare system.…”