Expanded testing for COVID-19 [SARS-CoV-2] to include monthly testing in the asympotomatic population as well as testing of symptomatic patients could be cost effective in Massachusetts, USA, according to findings of a study published in Clinical Infectious Diseases.

The Clinical and Economic Analysis of COVID-19 Interventions (CEACOV) microsimulation model was used to compared four polymerase chain reaction (PCR) testing strategies for COVID-19 in the Massachusetts population (excluding residents in long-term care): testing patients with severe or critical symptoms requiring hospitalisation (hospitalised); testing patients with any COVID-19 symptoms (symptomatic); testing symptomatic patients plus one-time testing in the entire population (symptomatic plus asymptomatic-once); or testing symptomatic patients plus monthly testing in the entire population (symptomatic plus asymptomatic-monthly). It was assumed that patients who tested COVID-19-positive would self-isolate. Cost effectiveness was assessed from a US healthcare sector perspective over a 180-day time horizon (from May to November 2020), under scenarios with a range of effective reproduction numbers (Re 0.9−2) for the transmission of COVID-19. It was assumed that the PCR test cost was $51.Footnote 1

It was estimated that all expanded testing strategies would be more effective than testing hospitalised patients only. Symptomatic plus asymptomatic-monthly testing would reduce the infection rate by 64% and the death rate by 46% compared with testing of hospitalised patients only but would incur five-fold higher costs at Re 0.9. However if the Re was 1.6 or greater, symptomatic plus asymptomatic-monthly testing would be cost effective, with an incremental cost-effectiveness ratio (ICER) below the willingness-to-pay threshold of $100 000 per QALY gained.

Sensitivity analysis found that symptomatic testing plus asymptomatic testing every 14 days would be cost effective at all Re values assessed if the cost of PCR test assays was $3 or less.

"Testing people with any COVID-19-consistent symptoms would be cost saving compared to testing only those whose symptoms warrant hospital care. Expanding SARS-CoV-2 PCR testing to asymptomatic people would reduce infections, deaths, and hospital resource use. Despite modest sensitivity, low-cost, repeat screening of the entire population could be cost-effective in all epidemic settings," concluded the authors.