Clinical Impact, Costs, and Cost-effectiveness of Expanded Severe Acute Respiratory Syndrome Coronavirus 2 Testing in Massachusetts
| Autor: | Mark J. Siedner, Kenneth A. Freedberg, Elena Losina, Guy Harling, Pooyan Kazemian, Amir M. Mohareb, Andrea L. Ciaranello, Justine A. Scott, Christopher Panella, G. Ege Eskibozkurt, Emily P. Hyle, Anne M. Neilan, Fatma M. Shebl, Clare Flanagan, Milton C. Weinstein, Audrey C. Bangs, Krishna P. Reddy |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Microbiology (medical)
Pediatrics medicine.medical_specialty Coronavirus disease 2019 (COVID-19) cost-effective Cost effectiveness Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Population Asymptomatic Article 03 medical and health sciences 0302 clinical medicine Pandemic Major Article medicine 030212 general & internal medicine education cost-effectiveness health care economics and organizations Entire population education.field_of_study model business.industry screening Incidence (epidemiology) Disease progression COVID-19 testing Editorial Commentary PCR AcademicSubjects/MED00290 Infectious Diseases Homogeneous 030220 oncology & carcinogenesis medicine.symptom business |
| Zdroj: | Clinical Infectious Diseases Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America medRxiv article-version (status) pre article-version (number) 1 |
| ISSN: | 1537-6591 1058-4838 |
| DOI: | 10.1093/cid/ciaa1418 |
| Popis: | Background We projected the clinical and economic impact of alternative testing strategies on coronavirus disease 2019 (COVID-19) incidence and mortality in Massachusetts using a microsimulation model. Methods We compared 4 testing strategies: (1) hospitalized: polymerase chain reaction (PCR) testing only for 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 1-time PCR for the entire population; and (4) symptomatic + asymptomatic monthly: symptomatic with monthly retesting 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 (ICERs, $/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 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. |
| Databáze: | OpenAIRE |
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