Cost-effectiveness of antigen testing for ending COVID-19 isolation

Maya, Sigal; Kahn, James G.

doi:10.1101/2022.03.21.22272687

Cited by 4 publications

(5 citation statements)

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“…Published in March 2021, the model represents pre-vaccination COVID-19 transmission rates and effects, which limits comparison with the current model. A more recent (preprint) economic evaluation of protocols for ending COVID-19 isolation focussed on the use of RATs to inform the duration of isolation, compared with a default scenario of 5-day isolation for all [19]. This evaluation modelled effects on secondary infections, for which the optimal testing strategy (test on day 6) cost an additional $1300 per secondary infection averted.…”

Section: Discussionmentioning

confidence: 99%

An Economic Evaluation of Government-Funded COVID-19 Testing in Australia

Karnon

Afzali

Bonevski

2022

Appl Health Econ Health Policy

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Objective Easy and equitable access to testing has been a cornerstone of the public health response to COVID-19. Currently in Australia, testing using polymerase chain reaction (PCR) tests for COVID-19 is free to the user, but government funding for rapid antigen tests (RATs) is limited. We conduct an economic analysis of alternative government policies regarding the funding of COVID-19 testing in Australia. Methods A decision tree model was developed to describe COVID-19 testing pathways for the Australian population over a 1-week period. The model outputs were analysed to estimate R numbers associated with alternative funding policies, which were used to estimate COVID-19 cases over a 6-month time horizon. Healthcare costs and quality-adjusted life-year (QALY) effects were applied to new COVID-19 cases. The model was populated using responses to a de novo population survey and published data sources. Results Compared with no government-funded COVID-19 testing, government-funded testing is estimated to generate large incremental net monetary benefits (INMBs), up to A$15 billion in the base-case analyses. Government-funded PCR testing and RATs for all is predicted to maximise INMBs in most tested scenarios, though funding RATs for all and not PCR tests has similar INMBs in many scenarios and generates higher benefits to costs ratios. Conclusions Our interpretation of the modelled analysis is that at the time of writing (July 2022), with high vaccination uptake in Australia and few other public health measures in place, Australian governments should consider reducing funding of PCR testing, for example, limiting capacity to essential workers and individuals with known risk factors for serious symptoms, and fund RATs for all.

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Section: Discussionmentioning

confidence: 99%

An Economic Evaluation of Government-Funded COVID-19 Testing in Australia

Karnon

Afzali

Bonevski

2022

Appl Health Econ Health Policy

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“…7 days and 10 days) with or without one negative lateral flow device on secondary infections or additional transmission risk. [12][13][14][15] However, none has focused on the most patient-important outcomesonward transmission leading to hospitalization or death.…”

Section: Introductionmentioning

confidence: 99%

Comparison of different isolation periods for preventing the spread of COVID-19: a rapid systematic review and a modelling study

Gao

Zhao

Zhang

et al. 2023

Preprint

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Background: The optimal isolation duration for COVID-19 patients remains unclear. To support an update of WHO Living Clinical management guidelines for COVID-19 (https://www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2022.2), this rapid systematic review and modelling study addresses the effects of different isolation periods for preventing onward transmission leading to hospitalization and death among secondary cases. Methods: We searched World Health Organization (WHO) COVID-19 database for clinical studies evaluating the impact of isolation periods for COVID-19 patients up to July 28, 2022. We performed random-effects meta-analyses to summarize testing rates of persistent test positivity rates after COVID-19 infection. We developed a model to compare the effects of the five-day isolation and removal of isolation based on a negative antigen test with ten-day isolation on onward transmission leading to hospitalization and death. We assumed that patients with a positive test are infectious and those with a negative test are not. If the test becomes negative, patients will stay negative. The model included estimates of test positivity rates, effective reproduction number, and hospitalization rate or case fatality rate. Findings: Twelve studies addressing persistent test positivity rates including 2799 patients proved eligible. Asymptomatic patients (27.1%, 95% CI: 15.8% to 40.0%) had a significantly lower rapid antigen test (RAT) positive rate than symptomatic patients (68.1%, 95% CI: 40.6% to 90.3%) on day 5. The RAT positive rate was 21.5% (95% CI: 0 to 64.1%; moderate certainty) on day 10. Our modelling study suggested that the risk difference (RD) for asymptomatic patients between five-day isolation and ten-day isolation in hospitalization (2 more hospitalizations of secondary cases per 1000 patients isolated, 95% uncertainty interval (UI) 2 more to 3 more) and mortality (1 more per 1000 patients, 95% UI 0 to 1 more) of secondary cases proved very small (very low certainty). For symptomatic patients, the potential impact of five- versus ten-day isolation was much greater in hospitalizations (RD 19 more per 1000 patients, 95% UI 14 more to 24 more; very low certainty) and mortality (RD 5 more per 1000 patients, 95% UI 4 more to 6 more; very low certainty). There may be no difference between removing isolation based on a negative antigen test and ten-day isolation in the onward transmission leading to hospitalization or death, but the average isolation period (mean difference -3 days) will be shorter for the removal of isolation based on a negative antigen test (moderate certainty). Interpretation: Five versus 10 days of isolation in asymptomatic patients may result in a small amount of onward transmission and negligible hospitalization and mortality, but in symptomatic patients concerning transmission and resulting hospitalization and mortality. The evidence is, however, very uncertain.

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“…7 days and 10 days) with or without one negative lateral flow device on secondary infections or additional transmission risk. 12 , 13 , 14 , 15 However, none has focused on the most patient-important outcomes - onward transmission leading to hospitalisation or death.…”

Section: Introductionmentioning

confidence: 99%