Clinical Impact, Costs, and Cost-effectiveness of Expanded Severe Acute Respiratory Syndrome Coronavirus 2 Testing in Massachusetts.
Clinical Impact, Costs, and Cost-effectiveness of Expanded Severe Acute Respiratory Syndrome Coronavirus 2 Testing in Massachusetts.
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DOI：
10.1093/cid/ciaa1418
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发表时间：
2021-11-02
期刊：
影响因子：
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通讯作者：
Ciaranello AL
中科院分区：
文献类型：
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作者：
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
我们使用微观模拟模型预测了替代检测策略对马萨诸塞州2019冠状病毒病（COVID-19）发病率和死亡率的临床和经济影响。 我们比较了4种检测策略：（1）住院：仅对有严重/危重症状且未住院的患者进行聚合酶链反应（PCR）检测;（2）症状性：对任何COVID-19一致症状进行PCR，如果阳性则进行自我隔离;（3）症状性+无症状性一次：对整个人群进行症状性和1次PCR;（4）症状性+无症状性每月一次：对整个人群进行症状性每月一次复检。 我们研究了有效再生产数（Re = 0.9-2.0），政策结论会发生变化。我们假设马萨诸塞州人群（不包括居住在长期护理机构的人群）均质混合。我们使用了已发表的疾病进展和死亡率、传播、PCR敏感性/特异性（70%/100%）和成本数据。模型预测的结果包括感染、死亡、进行的检查、住院天数和180天以上的费用，以及增量成本-效果比（ICER，$/质量调整生命年[QALY]）。 在Re = 0.9时，有症状+无症状每月一次与住院相比，感染减少64%，死亡减少46%，但每天需要多66倍的检测，费用高5倍。 只有当Re ≥1.6时，每月有症状+无症状的ICER <100 000美元/QALY;当测试成本≤ 3美元时，每14天测试在所有重新检查时都是成本效益的。 与只检测那些症状需要住院治疗的人相比，检测任何与COVID-19一致的症状的人将节省成本。将PCR检测扩大到无症状人群将减少感染、死亡和住院。尽管敏感性不高，但在所有流行病环境中，对整个人群进行低成本重复筛查可能具有成本效益。低成本（≤ 5美元），无症状人群的重复筛查将减少感染和死亡，即使在流行放缓的情况下也具有成本效益;如果测试成本≥ 50美元，有效繁殖数<1.6，则将测试限制在有症状的人群中将是经济上的首选。
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. 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]). 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. 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. Low-cost (≤$5), repeat screening of asymptomatic people would decrease infections and deaths and be cost-effective even when epidemics are slowing; if test costs are ≥$50, at an effective reproduction number <1.6, restricting testing to those with symptoms would be economically preferred.