Cost-effectiveness of anti-SARS-CoV-2 antibody diagnostic tests in Brazil

Abstract

Background Although serologic tests for COVID-19 diagnosis are rarely indicated nowadays, they remain commercially available and widely used in Brazil. The objective of this study was to evaluate the cost-effectiveness of anti-SARS-CoV-2antibody diagnostic tests for COVID-19 in Brazil. Methods Eleven commercially available diagnostic tests, comprising five lateral-flow immunochromatographic assays (LFAs) and six immunoenzymatic assays (ELISA) were analyzed from the perspective of the Brazilian Unified Health System. Results The direct costs of LFAs ranged from US$ 11.42 to US$ 17.41and of ELISAs, from US$ 6.59 to US$ 10.31. Considering an estimated disease prevalence between 5% and 10%, the anti-SARS-CoV-2 ELISA (IgG) was the most cost-effective test, followed by the rapid One Step COVID-19 Test, at an incremental cost-effectiveness ratio of US$ 2.52 and US$ 1.26 per properly diagnosed case, respectively. Considering only the LFAs, at the same prevalence estimates, two tests, the COVID-19 IgG/IgM and the One Step COVID-19 Test, showed high effectiveness at similar costs. For situations where the estimated probability of disease is 50%, the LFAs are more costly and less effective alternatives. Conclusions Nowadays there are few indications for the use of serologic tests in the diagnosis of COVID-19 and numerous commercially available tests, with marked differences are observed among them. In general, LFA tests are more cost-effective for estimated low-COVID-19-prevalences, while ELISAs are more cost-effective for high-pretest-probability scenarios.

Cost-effectiveness analysis of COVID-19 tests in the unified health system

“…In Brazil, the Ministry of Health recommends the choice of RT-PCR and TR-Ag tests for symptomatic patients in the acute phase and that they be collected until the 8th day of symptoms. However, our study demonstrates that TR-Ag can be especially used in the initial phase of the disease for screening and diagnosis, especially in environments where there is a limitation in the laboratory processing capacity [ 14 , 27 , 36 ]. In addition, some studies have shown false results-negatives in significant amount in the first days of infection (0 to 7 days) for RT-PCR [ 8 , 20 ].…”

“…Therefore, the notorious importance of detecting patients infected by SARS-CoV-2 for the control of the pandemic, there is a limited availability in the literature of economic analysis that guide the use of technology with the best cost-effectiveness ratio for this economic scenario [ 14 ]. Given the high availability of technologies and different brands available, decision-making by the public administration becomes complex [ 15 ].…”

Lateral flow assay: a promising rapid point-of-care testing tool for infections and non-communicable diseases

“…As discussed earlier in this review, rapid test kits for SARS-CoV-2 were not only cheaper but also easily accessible to the public, enabling instant testing and screening for the infection. This helped reduce the reliance on laboratory-based testing methods like RT-PCR, which, in addition to being laborious, incurred high costs in terms of personnel, machinery, and testing facilities [64]. Furthermore, cryptococcal antigen (CRAG)-LFA was used to screen for cryptococcal meningitis (CM) among HIV patients in Uganda.…”

Anti-SARS-CoV-2 IgG ELISA: Replacing the Absorbance Plate Reader by a Regular Scanner with Open-Source Software

“…Using data from the Brazilian public health system, de Assis et al [11] found that ELISA tests were more sensitive and cost-effective for high COVID-19 prevalence than LFIA, while LFIA had better specificity and was more costeffective for low COVID-19 prevalence. There are works focusing on developing more sensitive and accurate LFIA tests, with Guo et al [12] giving a good review.…”

“…Gong et al [13] and Mohit et al [14] found significant variance in performance in papers studying different tests. de Assis et al [11] compared several ELISA and LFIA tests simultaneously with similar study and control groups. Their results are summarized in Table 1.…”