Point-of-Care COVID-19 Antigen Testing in Exposed German Healthcare Workers—A Cost Model

Abstract

Background: Hospital staffing shortages are again (mid-year 2021) becoming a significant problem as the number of positive COVID-19 cases continues to increase worldwide. Objective: To assess the costs of sending HCW into quarantine (Scenario 1) from the hospital’s and the taxpayer’s perspective versus the costs arising from implementing point-of-care COVID-19 antigen testing (POCT) for those staff members who, despite learning that they have been exposed to hospital patients later found to be infected with COVID-19, continue to report to work (Scenario 2). Methods: A mathematical model was built to calculate the costs of a sample-and-stay strategy for exposed healthcare workers (HCW) in Germany by utilizing a high-quality antigen fluorescent immunoassay (FIA), compared to the costs of quarantine. Direct costs and wage costs were evaluated from the hospital as well as from the taxpayer perspective assuming a SARS-CoV-2 infection prevalence of 10%. Results: Serial POCT testing of exposed HCW in Germany (Scenario 2) who do not go into quarantine but continue to work during a post-exposure period of 14 days at their working place raises costs of EUR 289 (±20%: EUR 231 to EUR 346, rounded) per HCW at the expense of the employing hospital while the extra-costs to the taxpayer per exposed HCW are limited to EUR 16 (±20%: EUR 13 to EUR 19). In contrast, sending HCW into quarantine (Scenario 1) would result in costs of EUR 111 (±20%: EUR 89 to EUR 133) per exposed HCW for the hospital but EUR 2235 (±20%: EUR 1744 to EUR 2727) per HCW at the expense of the taxpayer. Conclusions: Monitoring exposed HCW who continued working by sequential POCT may considerably reduce costs from the perspective of the taxpayer and help mitigate personnel shortages in hospitals during pandemic COVID-19 waves.

Cumulative Incidence of SARS-CoV-2 in Healthcare Workers at a General Hospital in Germany during the Pandemic—A Longitudinal Analysis

“…The rate of positive PCR in this study varied between 1.1% and 7.1%. Considering these values, it seems likely that a point of care (PoC) test followed by a PCR is more efficient for screening asymptomatic HW [ 27 ]. How the Omicron variant might change this perspective remains to be verified.…”

Willingness to Work during Public Health Emergencies: A Systematic Literature Review

“…The articles researching willingness and preparedness of health professionals during the COVID-19 pandemic correspond to a wide array of geographical contexts, given the worldwide reach of this threat: Palestine [ 32 ], Australia [ 33 , 105 ], Saudi Arabia [ 95 ], China [ 58 , 73 , 74 , 97 , 106 ], Ethiopia [ 37 , 107 ], Bangladesh [ 38 ], Spain [ 32 ], South Korea [ 43 , 47 ], Germany [ 46 , 108 ], Nepal [ 84 , 99 ], Qatar [ 82 ], Canada [ 42 ], Jordan [ 35 , 36 ], and Singapore [ 100 ].…”

Pooled analysis of diagnostic performance of the instrument-read Quidel Sofia SARS antigen Fluorescent Immunoassay (FIA)

“…Two additional studies, excluded from our pooled analysis because they lacked clinical performance data deserve to be briefly mentioned. Deil et al carried out a preliminary analysis by constructing a mathematical model for estimating the economical burden of sample-and-stay strategy in German healthcare workers based on the use of Quidel Sofia SARS Ag FIA, and concluded that sequential testing was effective to significantly lower the cumulative hospital expenditure due to shortage of quarantined hospital staff [ 43 ]. In a subsequent investigation, the same authors explored the economic impact of using the Quidel Sofia SARS Ag FIA compared to that based on clinical judgement and NAAT for diagnosing COVID-19 in a cohort of German adult patients presenting to the emergency department, concluding that the RDT-AG test enabled to substantially reduce hospital costs by over 200 € for each patient tested [ 44 ].…”