COVID-19 polymerase chain reaction testing before endoscopy: an economic analysis

Abstract

Background and Aims: The novel coronavirus disease 2019 (COVID-19) pandemic has limited endoscopy utilization, causing significant health and economic losses. We aim to model the impact of polymerase chain reaction (PCR) testing into resuming endoscopy practice. Methods: We performed a retrospective review of endoscopy utilization during the COVID-19 pandemic for a baseline reference. A computer model compared 3 approaches: strategy 1, endoscopy for urgent indications only; strategy 2, testing for semiurgent indications; and strategy 3, testing all patients. Analysis was made under current COVID-19 prevalence and projected prevalence of 5% and 10%. Primary outcomes were number of procedures performed and/or canceled. Secondary outcomes were direct costs, reimbursement, personal protective equipment used, and personnel infected. Disease prevalence, testing accuracy, and costs were obtained from the literature. Results: During the COVID-19 pandemic, endoscopy volume was 12.7% of expected. Strategies 2 and 3 were safe and effective interventions to resume endoscopy in semiurgent and elective cases. Investing 22 U.S. dollars (USD) and 105 USD in testing per patient allowed the completion of 19.4% and 95.3% of baseline endoscopies, respectively. False-negative results were seen after testing 4700 patients (or 3 months of applying strategy 2 in our practice). Implementing PCR testing over 1 week in the United States would require 13 and 64 million USD, with a return of 165 and 767 million USD to providers, leaving 65 and 325 healthcare workers infected. Conclusions: PCR testing is an effective strategy to restart endoscopic practice in the United States. PCR screening should be implemented during the second phase of the pandemic, once the healthcare system is able to test and isolate all suspected COVID-19 cases. (Gastrointest Endosc 2020;92:524-34.)

Characteristics and Outcomes of Patients Undergoing Endoscopy During the COVID-19 Pandemic: A Multicenter Study from New York City

“…Patients who were later diagnosed with COVID were more likely to have outpatient procedures compared to patients who were already known to have COVID, so it is important not to limit testing to inpatients. Economic analysis has suggested that universal pre-endoscopy COVID PCR testing is a cost-effective strategy for reopening endoscopy units, and our findings add further weight to this policy, which has already been implemented in many centers [13]. In addition to screening for COVID, we suggest providers use of N95 respirators and face shields in addition to standard personal protective equipment, restrict the number of unnecessary personnel, and carefully weigh the risks and benefits of endoscopic procedures, in order to limit transmission of coronavirus as much as possible.…”

Economic model to restart endoscopy practice needs to consider impact on health disparity in minority groups

“… 1 The authors conclude that PCR testing is an effective strategy to be implemented during the recovery phase. 1 …”

“…We read the timely article by Corral et al 1 on the economic analysis of COVID-19 polymerase chain reaction (PCR) testing before endoscopy with great interest. After initially choosing to postpone elective procedures, healthcare facilities are seeking strategies to safely resume endoscopy to address the growing list of waiting patients.…”

“…The results revealed that PCR testing for semiurgent and elective endoscopies for 1 week will require $13 million and $64 million, respectively, with a reimbursement of $165 million and $767 million. 1 Potentially, 65 and 325 workers, respectively, may become infected. 1 The authors conclude that PCR testing is an effective strategy to be implemented during the recovery phase.…”

“… 1 Potentially, 65 and 325 workers, respectively, may become infected. 1 The authors conclude that PCR testing is an effective strategy to be implemented during the recovery phase. 1 …”