Dataset Information

Clinical and Economic Effects of Widespread Rapid Testing to Decrease SARS-CoV-2 Transmission.

ABSTRACT:

Background

The value of frequent, rapid testing to reduce community transmission of SARS-CoV-2 is poorly understood.

Objective

To define performance standards and predict the clinical, epidemiologic, and economic outcomes of nationwide, home-based antigen testing.

Design

A simple compartmental epidemic model that estimated viral transmission, portrayed disease progression, and forecast resource use, with and without testing.

Data sources

Parameter values and ranges as informed by Centers for Disease Control and Prevention guidance and published literature.

Target population

U.S. population.

Time horizon

60 days.

Perspective

Societal; costs included testing, inpatient care, and lost workdays.

Intervention

Home-based SARS-CoV-2 antigen testing.

Outcome measures

Cumulative infections and deaths, number of persons isolated and hospitalized, and total costs.

Results of base-case analysis

Without a testing intervention, the model anticipates 11.6 million infections, 119 000 deaths, and $10.1 billion in costs ($6.5 billion in inpatient care and $3.5 billion in lost productivity) over a 60-day horizon. Weekly availability of testing would avert 2.8 million infections and 15 700 deaths, increasing costs by $22.3 billion. Lower inpatient outlays ($5.9 billion) would partially offset additional testing expenditures ($12.5 billion) and workdays lost ($14.0 billion), yielding incremental cost-effectiveness ratios of $7890 per infection averted and $1 430 000 per death averted.

Results of sensitivity analysis

Outcome estimates vary widely under different behavioral assumptions and testing frequencies. However, key findings persist across all scenarios, with large reductions in infections, mortality, and hospitalizations. Costs per death averted are roughly an order of magnitude lower than commonly accepted willingness-to-pay values per statistical life saved ($5 to $17 million).

Limitations

Analysis was restricted to at-home testing. There are uncertainties concerning test performance.

Conclusion

High-frequency home testing for SARS-CoV-2 with an inexpensive, imperfect test could contribute to pandemic control at justifiable cost and warrants consideration as part of a national containment strategy.

Primary funding source

National Institutes of Health.

SUBMITTER: Paltiel AD

PROVIDER: S-EPMC9317280 | biostudies-literature | 2021 Jun

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Clinical and Economic Effects of Widespread Rapid Testing to Decrease SARS-CoV-2 Transmission.

Paltiel A David AD Zheng Amy A Sax Paul E PE

Annals of internal medicine 20210309 6

<h4>Background</h4>The value of frequent, rapid testing to reduce community transmission of SARS-CoV-2 is poorly understood.<h4>Objective</h4>To define performance standards and predict the clinical, epidemiologic, and economic outcomes of nationwide, home-based antigen testing.<h4>Design</h4>A simple compartmental epidemic model that estimated viral transmission, portrayed disease progression, and forecast resource use, with and without testing.<h4>Data sources</h4>Parameter values and ranges a ...[more]

PMID: 33683930

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Project description:ObjectivesTo evaluate the potential for long distance airborne transmission of SARS-CoV-2 in indoor community settings and to investigate factors that might influence transmission.DesignRapid systematic review and narrative synthesis.Data sourcesMedline, Embase, medRxiv, Arxiv, and WHO COVID-19 Research Database for studies published from 27 July 2020 to 19 January 2022; existing relevant rapid systematic review for studies published from 1 January 2020 to 27 July 2020; and citation analysis in Web of Science and Cocites.Eligibility criteria for study selectionObservational studies reporting on transmission events in indoor community (non-healthcare) settings in which long distance airborne transmission of SARS-CoV-2 was the most likely route. Studies such as those of household transmission where the main transmission route was likely to be close contact or fomite transmission were excluded.Data extraction and synthesisData extraction was done by one reviewer and independently checked by a second reviewer. Primary outcomes were SARS-CoV-2 infections through long distance airborne transmission (>2 m) and any modifying factors. Methodological quality of included studies was rated using the quality criteria checklist, and certainty of primary outcomes was determined using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. Narrative synthesis was themed by setting.Results22 reports relating to 18 studies were identified (methodological quality was high in three, medium in five, and low in 10); all the studies were outbreak investigations. Long distance airborne transmission was likely to have occurred for some or all transmission events in 16 studies and was unclear in two studies (GRADE: very low certainty). In the 16 studies, one or more factors plausibly increased the likelihood of long distance airborne transmission, particularly insufficient air replacement (very low certainty), directional air flow (very low certainty), and activities associated with increased emission of aerosols, such as singing or speaking loudly (very low certainty). In 13 studies, the primary cases were reported as being asymptomatic, presymptomatic, or around symptom onset at the time of transmission. Although some of the included studies were well conducted outbreak investigations, they remain at risk of bias owing to study design and do not always provide the level of detail needed to fully assess transmission routes.ConclusionThis rapid systematic review found evidence suggesting that long distance airborne transmission of SARS-CoV-2 might occur in indoor settings such as restaurants, workplaces, and venues for choirs, and identified factors such as insufficient air replacement that probably contributed to transmission. These results strengthen the need for mitigation measures in indoor settings, particularly the use of adequate ventilation.Systematic review registrationPROSPERO CRD42021236762.

Dataset Information

Clinical and Economic Effects of Widespread Rapid Testing to Decrease SARS-CoV-2 Transmission.

Background

Objective

Design

Data sources

Target population

Time horizon

Perspective

Intervention

Outcome measures

Results of base-case analysis

Results of sensitivity analysis

Limitations

Conclusion

Primary funding source

Publications

Clinical and Economic Effects of Widespread Rapid Testing to Decrease SARS-CoV-2 Transmission.

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