Table 2.
Clinical and Cost-effectiveness Outcomes for a Model of Coronavirus Disease 2019 Infection and Testing in Massachusetts
| Scenario | Undiscounted | Undiscounted | Discounted | Undiscounted | Discounted |
|---|---|---|---|---|---|
| Incident Infections, No.a | Deaths, No.a | Total QALYs Lost, No.b | Healthcare Costs, USDa,c | ICER, USD/QALYc | |
| Slowing scenario (1 June 2020, Re = 0.9) | |||||
| Symptomatic | 315 700 | 2200 | 11 900 | 342 787 000 | … |
| Hospitalized | 577 700 | 3100 | 16 400 | 439 495 000 | Dominated |
| Symptomatic + asymptomatic once | 268 100 | 2000 | 10 500 | 605 505 000 | 194 000 |
| Symptomatic + asymptomatic monthly | 209 500 | 1700 | 8900 | 2 024 106 000 | 908 000 |
| Intermediate scenario (1 June 2020, Re = 1.3) | |||||
| Symptomatic | 680 600 | 3400 | 18 300 | 488 896 000 | … |
| Symptomatic + asymptomatic once | 579 200 | 3000 | 16 100 | 727 290 000 | 110 000 |
| Hospitalized | 1 696 800 | 6800 | 36 100 | 849 882 000 | Dominated |
| Symptomatic + asymptomatic monthly | 333 700 | 2100 | 11 400 | 2 091 084 000 | 287 000 |
| Surging scenario (1 June 2020, Re = 2.0) | |||||
| Symptomatic | 3 374 200 | 13 700 | 72 600 | 1 608 128 000 | … |
| Symptomatic + asymptomatic once | 3 258 100 | 13 000 | 68 800 | 1 831 196 000 | Dominated |
| Hospitalized | 4 444 300 | 18 300 | 97 200 | 2 090 289 000 | Dominated |
| Symptomatic + asymptomatic monthly | 1 884 000 | 7100 | 37 700 | 2 757 024 000 | 33 000 |
Strategies are listed in order of increasing cost as per cost-effectiveness analysis convention. Infections, deaths, and life-years lost are rounded to the nearest 100. Costs and ICERs are rounded to the nearest 1000. In-text results describing percentages are calculated from unrounded results.
Abbreviations: ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life-year; Re, effective reproduction number; USD, United States dollars.
aIncludes 180-day horizon between simulated days 1 May 2020 and 1 November 2020.
b Total life-years lost were estimated from coronavirus disease 2019–related deaths occurring over 180 days. Details are shown in the Supplementary Materials.
cIncremental cost-effectiveness ratios are calculated by dividing the difference in total healthcare-related costs by the difference in total QALYs lost 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 2 other strategies (weak dominance). Total QALYs lost are discounted at 3%/year; because all healthcare costs occur in year 1, costs are not discounted in the base case. Additional details of calculating ICERs are shown in the Supplementary Materials.