Table 2.
Clinical and cost-effectiveness outcomes for a model of COVID-19 disease and testing in Massachusetts
| Undiscounted | Undiscounted | Discounted | Undiscounted | Discounted | |
|---|---|---|---|---|---|
| Incident infections, No. a |
Deaths, No. a |
Total life-years lost, No. b |
Healthcare costs, $ a |
ICER, $/QALY c |
|
| Slowing scenario (June 1, 2020 Re 0.9) | |||||
| PCR-any-symptom | 316,300 | 2,300 | 7,300 | 393,037,000 | - |
| Self-screen | 422,200 | 2,600 | 8,200 | 428,461,000 | dominated |
| PCR-severe-only | 565,300 | 3,200 | 10,100 | 492,552,000 | dominated |
| PCR-all | 281,000 | 2,100 | 6,700 | 654,741,000 | 394,000 |
| PCR-all-repeat | 210,200 | 1,800 | 5,800 | 2,071,400,000 | 1,540,000 |
| Intermediate scenario (June 1, 2020 Re 1.3) | |||||
| PCR-any-symptom | 604,600 | 3,500 | 11,100 | 506,489,000 | - |
| Self-screen | 975,200 | 4,400 | 14,100 | 636,392,000 | dominated |
| PCR-all | 543,900 | 3,000 | 9,700 | 768,358,000 | 181,000 |
| PCR-severe-only | 1,471,100 | 6,300 | 20,100 | 832,028,000 | dominated |
| PCR-all-repeat | 298,300 | 2,100 | 6,800 | 2,111,387,000 | 468,000 |
| Surging scenario (June 1, 2020 Re 2.0) | |||||
| PCR-any-symptom | 2,924,200 | 11,800 | 37,600 | 1,421,427,000 | - |
| PCR-all | 2,799,400 | 11,300 | 36,000 | 1,673,911,000 | dominated |
| Self-screen | 3,666,900 | 14,700 | 46,500 | 1,753,092,000 | dominated |
| PCR-severe-only | 4,193,800 | 17,300 | 55,000 | 2,010,507,000 | dominated |
| PCR-all-repeat | 1,232,500 | 5,200 | 16,600 | 2,532,432,000 | 53,000 |
Abbreviations: No., Number; PCR, Polymerase chain reaction; Re, Effective reproduction number; $, US dollars; ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life-year
Includes 180-day horizon between simulated days May 1, 2020 and November 1, 2020.
Total life-years lost were estimated from COVID-related deaths occurring over 180-days. Details are in the Supplementary Material.
Incremental cost effectiveness ratios are calculated by dividing the difference in total life-years lost by the difference in total healthcare-related costs compared to the next most expensive strategy. Dominated strategies are either more expensive and less effective than another strategy (strong dominance) or a combination of two other strategies (weak dominance). Strategies are listed in order of increasing cost as per cost-effectiveness analysis convention. Total life-years lost are discounted at 3%/year; because all healthcare costs occur in year one, costs are not discounted in the base case. Additional details of calculating ICERs may be found in the Supplementary Material.
Infections, deaths, and life-years lost are rounded to the nearest 100. Costs and ICERs are rounded to the nearest 1,000. In-text results describing percentages are calculated from unrounded results.