Cost-effectiveness of a whole-area testing pilot of asymptomatic SARS-CoV-2 infections with lateral flow devices: a modelling and economic analysis study

被引:10
作者
Drakesmith, Mark [1 ]
Collins, Brendan [2 ,3 ]
Jones, Angela [4 ]
Nnoaham, Kelechi [4 ]
Thomas, Daniel Rhys [1 ,5 ]
机构
[1] Publ Hlth Wales, Communicable Dis Surveillance Ctr, Cardiff, Wales
[2] Welsh Govt, Hlth & Social Serv Grp, Cardiff, Wales
[3] Univ Liverpool, Dept Publ Hlth Policy & Syst, Liverpool, Merseyside, England
[4] Cwm Taf Morgannwg Univ Hlth Board, Abercynon, Rhondda Cynon T, Wales
[5] Cardiff Metropolitan Univ, Sch Hlth Sci, Cardiff, Wales
关键词
Covid-19; SARS-CoV-2; Lateral flow test; Mass testing; Community testing; Cost-effectiveness; Economic analysis; Epidemiological modelling; QALYs; COVID-19;
D O I
10.1186/s12913-022-08511-3
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background Mass community testing for SARS-CoV-2 by lateral flow devices (LFDs) aims to reduce prevalence in the community. However its effectiveness as a public heath intervention is disputed. Method Data from a mass testing pilot in the Borough of Merthyr Tydfil in late 2020 was used to model cases, hospitalisations, ICU admissions and deaths prevented. Further economic analysis with a healthcare perspective assessed cost-effectiveness in terms of healthcare costs avoided and QALYs gained. Results An initial conservative estimate of 360 (95% CI: 311-418) cases were prevented by the mass testing, representing a would-be reduction of 11% of all cases diagnosed in Merthyr Tydfil residents during the same period. Modelling healthcare burden estimates that 24 (16-36) hospitalizations, 5 (3-6) ICU admissions and 15 (11-20) deaths were prevented, representing 6.37%, 11.1% and 8.2%, respectively of the actual counts during the same period. A less conservative, best-case scenario predicts 2333 (1764-3115) cases prevented, representing 80% reduction in would-be cases. Cost -effectiveness analysis indicates 108 (80-143) QALYs gained, an incremental cost-effectiveness ratio of 2,143 pound (860- pound 4,175) pound per QALY gained and net monetary benefit of 6.2 pound m (4.5 pound m-8.4 pound m). In the best-case scenario, this increases to 15.9 pound m (12.3 pound m-20.5 pound m). Conclusions A non-negligible number of cases, hospitalisations and deaths were prevented by the mass testing pilot. Considering QALYs gained and healthcare costs avoided, the pilot was cost-effective. These findings suggest mass testing with LFDs in areas of high prevalence (> 2%) is likely to provide significant public health benefit. It is not yet clear whether similar benefits will be obtained in low prevalence settings or with vaccination rollout.
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