COVID-19 polymerase chain reaction testing before endoscopy: an economic analysis.

Autor: Corral JE; Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA., Hoogenboom SA; Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA., Kröner PT; Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA., Vazquez-Roque MI; Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA., Picco MF; Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA., Farraye FA; Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA., Wallace MB; Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA.
Jazyk: angličtina
Zdroj: Gastrointestinal endoscopy [Gastrointest Endosc] 2020 Sep; Vol. 92 (3), pp. 524-534.e6. Date of Electronic Publication: 2020 Apr 28.
DOI: 10.1016/j.gie.2020.04.049
Abstrakt: Background and Aims: The novel coronavirus disease 2019 (COVID-19) pandemic has limited endoscopy utilization, causing significant health and economic losses. We aim to model the impact of polymerase chain reaction (PCR) testing into resuming endoscopy practice.
Methods: We performed a retrospective review of endoscopy utilization during the COVID-19 pandemic for a baseline reference. A computer model compared 3 approaches: strategy 1, endoscopy for urgent indications only; strategy 2, testing for semiurgent indications; and strategy 3, testing all patients. Analysis was made under current COVID-19 prevalence and projected prevalence of 5% and 10%. Primary outcomes were number of procedures performed and/or canceled. Secondary outcomes were direct costs, reimbursement, personal protective equipment used, and personnel infected. Disease prevalence, testing accuracy, and costs were obtained from the literature.
Results: During the COVID-19 pandemic, endoscopy volume was 12.7% of expected. Strategies 2 and 3 were safe and effective interventions to resume endoscopy in semiurgent and elective cases. Investing 22 U.S. dollars (USD) and 105 USD in testing per patient allowed the completion of 19.4% and 95.3% of baseline endoscopies, respectively. False-negative results were seen after testing 4700 patients (or 3 months of applying strategy 2 in our practice). Implementing PCR testing over 1 week in the United States would require 13 and 64 million USD, with a return of 165 and 767 million USD to providers, leaving 65 and 325 healthcare workers infected.
Conclusions: PCR testing is an effective strategy to restart endoscopic practice in the United States. PCR screening should be implemented during the second phase of the pandemic, once the healthcare system is able to test and isolate all suspected COVID-19 cases.
(Copyright © 2020 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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