COVID-19 polymerase chain reaction testing before endoscopy: an economic analysis
COVID-19 polymerase chain reaction testing before endoscopy: an economic analysis
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DOI：
10.1016/j.gie.2020.04.049
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发表时间：
2020-09-01
影响因子：
7.7
通讯作者：
Wallace, Michael B.
中科院分区：
文献类型：
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作者：
Corral, Juan E.;Hoogenboom, Sanne A.;Wallace, Michael B.
背景和目标：2019年新型冠状病毒病（COVID-19）大流行限制了内窥镜的使用，造成了重大的健康和经济损失。我们的目标是模拟聚合酶链反应（PCR）检测恢复内镜practice.Methods的影响：我们进行了一项回顾性研究，在COVID-19大流行期间的内镜使用基线参考。一个计算机模型比较了3种方法：策略1，仅紧急适应症的内镜检查;策略2，半紧急适应症的测试;策略3，测试所有患者。分析乃根据当前COVID-19流行率及预测流行率5%及10%进行。主要结局是进行和/或取消的手术数量。次要结果是直接成本、报销、使用的个人防护设备和人员感染。疾病患病率、检测准确性和成本均来自文献。结果：在COVID-19大流行期间，内镜检查量为预期的12.7%。策略2和3是安全有效的干预措施，可以在半紧急和择期病例中恢复内镜检查。每名患者在检测上投资22美元（USD）和105美元，分别完成了基线内窥镜检查的19.4%和95.3%。在对4700名患者进行测试后（或在我们的实践中应用策略2 3个月），观察到假阴性结果。实施PCR检测超过1周，在美国将需要13和64万美元，与165和767万美元的回报供应商，离开65和325医护人员infected.Conclusions：PCR检测是一种有效的策略，在美国重新启动内镜实践。一旦医疗系统能够检测和隔离所有疑似COVID-19病例，应在大流行的第二阶段实施PCR筛查。
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.