Cost analysis of coronavirus disease 2019 test strategies using pooled reverse transcriptase‐polymerase chain reaction technique

Abstract

Background This study aimed to compare the testing strategies for COVID‐19 (i.e., individual, simple pooling, and matrix pooling) in terms of cost. Methods We simulated the total expenditures of each testing strategy for running 10,000 tests. Three parameters were used: positive rate (PR), pool size, and test cost. We compared the total testing costs under two hypothetical scenarios in South Korea. We also simulated country‐specific circumstances in India, South Africa, South Korea, the UK, and the USA. Results At extreme PRs of 0.01% and 10%, simple pooling was the most economic option and resulted in cost reductions of 98.0% (pool size ≥80) and 36.7% (pool size = 3), respectively. At moderate PRs of 0.1%, 1%, 2%, and 5%, the matrix pooling strategy was the most economic option and resulted in cost reductions of 97.0% (pool size ≥88), 86.1% (pool size = 22), 77.9% (pool size = 14), and 59.2% (pool size = 7), respectively. In both hypothetical scenarios of South Korea, simple pooling costs less than matrix pooling. However, the preferable options for achieving cost savings differed depending on each country's cost per test and PRs. Conclusions Both pooling strategies resulted in notable cost reductions compared with individual testing in most scenarios pertinent to real‐life situations. The appropriate type of testing strategy should be chosen by considering the PR of COVID‐19 in the community and the test cost while using an appropriate pooling size such as five specimens.

Optimization of Screening Strategies for COVID-19: Scoping Review

“…Research on matrix pooling for COVID-19 has only mathematically simulated the number of tests and the accuracy of the pooled sample test. The Dorfman pool test may be more economical when the prevalence is extremely low, whereas matrix pooling may be more economical when the prevalence is relatively high [ 74 ]. Žilinskas et al [ 75 ] broadened the concept of matrices by dividing each sample into 2 pools to create as many links as possible between pools.…”

“…The selection of a screening strategy in realistic scenarios requires a balanced consideration of the economic costs and effectiveness of controlling the outbreak. Only a few studies reviewed in this paper analyzed cost-effectiveness in a cursory manner; for example, the simple indexes such as cost per test [ 74 ] or cost per infection reduced [ 82 ] were used. Furthermore, attention should also be paid to resource consumption, such as medical resources (eg, hospital beds) and quarantine resources (eg, hotel rooms), which determine the feasibility and sustainability of the strategy [ 95 ].…”