Neilan, AM; Losina, E; Bangs, AC; Flanagan, C; Panella, C; Eskibozkurt, GE; Mohareb, A; ... Ciaranello, AL; + view all Neilan, AM; Losina, E; Bangs, AC; Flanagan, C; Panella, C; Eskibozkurt, GE; Mohareb, A; Hyle, EP; Scott, JA; Weinstein, MC; Siedner, MJ; Reddy, KP; Harling, G; Freedberg, KA; Shebl, FM; Kazemian, P; Ciaranello, AL; - view fewer (2020) Clinical Impact, Costs, and Cost-Effectiveness of Expanded SARS-CoV-2 Testing in Massachusetts. Clinical Infectious Diseases 10.1093/cid/ciaa1418. (In press).

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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.

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