Table 3.
Summary results of included economic evaluation studies.
| Study, Year | Price/Year | Study Model | Threshold | Health Outcome | Cost | ICER | Is cost effective? |
|---|---|---|---|---|---|---|---|
| Reddy 2021 [23] | 2019 US$ | dynamic microsimulation model | US$ 3014.77 |
Re*, 1.5 HT*:450 940 HT, CT*, IC*,MS*, and QC*:27 220 HT and CT:322 970 HT, CT, IC,and MS:60 930 HT, CT, and IC:128 890 HT, CT, IC,and QC:60 190 Re 1·2 HT, CT, IC,and QC:3890 HT, CT, and IC: 6850 HT, CT, IC,and MS:4260 HT, CT, IC,MS, and QC:2040 HT and CT:32 040 HT:97 600 |
Re, 1.5 HT:437 000 000 HT, CT, IC,MS, and QC:581 000 000 HT and CT HT, CT, IC,and MS:668 000 000 HT, CT, and IC:780 000 000 HT, CT, IC,and QC:965 000 000 Re 1·2 HT, CT, IC,and QC:139 000 000 HT, CT, and IC:141 000 000 HT, CT, IC,and MS:183 000 000 HT, CT, IC,MS, and QC:190 000 000 HT and CT:276 000 000 HT:393 000 000 |
Re, 1.5 HT, CT, IC,MS, QC:340 HT, CT:Dominated HT, CT, IC,and MS: Dominated HT, CT, IC: Dominated HT, CT, IC,QC: Dominated Re 1·2 HT, CT, IC: Dominated HT, CT, IC, MS: Dominated HT, CT, IC,MS, QC:27 590 HT, CT: Dominated HT: Dominated |
Re 1·2–1·5: HT, CT, IC,MS, and QC was cost-effective With high epidemic growth (Re of 2·6): -no combination of the modelled interventions was cost-effective compared with HT. |
| Zhanwei Du 2021(25) | 2020US$ | dynamic microsimulation model | US$ 2 00 000 |
Assuming each test costs US$5 and assuming a societal willingness to pay per YLL* averted of $100000 Re → Test Intervals + Isolation = cost per test Re = 1·1 →every 28days +1 week = $75 Re = 1.2→every 28days+1week = $125 Re = 1·3→every 14days +1 week = $175 Re = 1·4→every 14days +1 week = $350 Re = 1·5→every 7days +1 week = $325 Re = 1·6→every 7days +1 week = $375 Re = 1·7→every 7days +1 week = $425 Re = 1·8→every 7days +1 week = $475 Re = 1·9→every 7days +2 weeks = $450 Re = 2·0→every 7days +2 weeks = $375 Re = 2·1→every 7days +2 weeks = $350 Re = 2·2→every 7days +2 weeks = $400 Re = 2·5→every 1day +2 weeks = $400 Re = 3→every 1day +2 weeks = $275 |
1-The most costly option we considered was daily testing coupled with a 2-week isolation period. 2-weekly testing coupled with 2-week isolation under high transmission scenarios (Re: 2·2) = the optimal strategy 3-testing every 14 days with 1-week isolation = the optimal strategy under moderate transmission rates (Re:1·3–1·4) 4-monthly testing with 1-week isolation = the optimal strategy for lower transmission scenarios (Re:1·1–1·2) |
Expanded surveillance is more cost-effective than the status-quo scenario if the price per test is less than $75 across all transmission rates. | The optimal strategy will depend on the transmission rate of the virus. 1-In high transmission: weekly testing coupled with a 2-week isolation period after a positive test is advisable and frequent surveillance testing at least monthly is preferred to the status quo of symptom-based would be an efficient use of resources. More frequent testing combined with reduced duration of isolation has a greater impact and is more cost-effective. |
| Matt Stevenson 2021 [8] | Great British pounds at 2020 values | dynamic microsimulation model | £20 000, £30 000 and £50 000, |
in the seeded en suite model: Total QALY* loss for each 13 strategies respectively: 3.72 -2.15- 1.89- 2.50–2.27 -2.10- 2.10- 2.50- 2.82- 2.37- 2.97- 2.17- 2.89 in the seeded shared facility model: Total QALY loss for each 13 strategies respectively: 3.97- 3.19- 3.09- 3.03- 2.89- 3.16- 3.28- 2.99- 3.13- 3.37- 3.31- 3.23- 3.21 |
Strategy: in the seeded en suite mode 1-162 (£) 2–5500 (£) 3–5459 (£) 4-5677 (£) 5–5617 (£) 6–6099 (£) 7-6143 (£) 8–6323 (£) 9–6351 (£) 10-5298 (£) 11–5436 (£) 12-5521 (£) 13–5747(£) Strategy: in the seeded shared facility model 1-172(£) 2–5776(£) 3–5741(£) 4–5807(£) 5–5781(£) 6–6303(£) 7–6314(£) 8–6343(£) 9–6337(£) 10–5601(£) 11–5820(£) 12–5579(£) 13–5834(£) Strategy: in the non-seeded en suite model 1-22(£) 2–4728(£) 3–4707(£) 4–4918(£) 5–4903(£) 6–5755(£) 7–5771(£) 8–5972(£) 9–5977(£) 10–4208(£) 11–4730(£) 12–4297(£) 13–4943(£) Strategy: in the non-seeded shared facility mode 1-22(£) 2–4737(£) 3–4705(£) 4–4854(£) 5–4858(£) 6–5768(£) 7–5757(£) 8–5909(£) 9–5926(£) 10–4201(£) 11–4726(£) 12–4269(£) 13–4899(£) |
ICERs* for the en suite residential care facility: (A = Acceptable/D = Desirable) No early release permitted: POC* D& PCR* D = Dominating POC A& PCR A = 5621(£) POC A& PCR D = Dominated POC D& PCR A = Dominating Early release permitted: POC D& PCR D = Dominating POC A& PCR A = Dominated POC A& PCR D = Dominated POC D& PCR A = Dominating ICERs for the shared facilities residential care facility: No early release permitted: POC D& PCR D = Dominating POC A& PCR A = Dominated POC A& PCR D = Dominated POC D& PCR A = Dominating Early release permitted: POC D& PCR D = Dominating POC A& PCR A = Dominated POC A& PCR D = Dominated POC D& PCR A = Dominating |
1-NMB* of both POC & PCR tests of SARS-CoV-2 is greater than that of the acceptable TPPs*. 2- POCT with desirable TPP, there is potential benefit associated with SARS-CoV-2 POCT SARS-CoV-2 POCTs have considerable potential for benefit in residential care facilities, but it is dependent on the diagnostic accuracy and the costs of forthcoming SARS-CoV-2 POCTs. |
| Matt Stevenson 2021 [28] | Great British pounds at 2020 values | dynamic microsimulation model | £20 000, £30 000 and £50 000 |
The QALYs lost associated to each 28 strategies respectively: 33.81- 35.56- 39.53- 39.32- 35.86- 36.61- 38.86- 41.24- 41.23- 38.8- 35.78- 38.46- 35.80- 38.18- 37.15- 36.31- 38.25- 35.93- 38.68- 36.77- 38.56- 39.02- 40.64- 38.72- 40.52- 39.57- 38.08- 40.27 |
1- costs of tests performed (the cost of laboratory tests equal to the costs of POCTs) 2- the costs of additional intensive care unit requirement 3- the cost-per-QALY ratio |
strategy 1, strategy 12 (£90 025) strategy 23 (£308 993) strategy 9 (£547 329) and strategy 8 (£52 577 110) strategy 24 Dominated strategy 25 (£ 25 625) |
SARS-CoV-2 POCT with a desirable TPP: a relatively high NMB depending on the cost-per-QALY threshold SARS-CoV-2 POCT has the acceptable TPP: a lower NMB than a SARS-CoV-2 laboratory-based test To assess the cost-effectiveness of SARS-CoV-2 POCTs, we need further information on the costs, turnaround times and diagnostic accuracy |
| R.Diel 2021 [22] | 2021 Euros | A decision-analytic model | German threshold | a negative POCT result one day earlier discharge results in a cost saving of €50. Reducing the base case value of 68.3 to60.0% (worst case) results in a further cost savings of €48.90 on top of the €212.57. performing POCT on each patient prior to hospitalization reduces the costs that occur when COVID-19 suspects are isolated based only on the conventional clinical approach, by €209.91 |
1-the costs of routine diagnostics (chest X-ray, routine laboratory values, physical examination) 2- the costs of POCT 3- Costs of RT-PCR performed in external laboratory 4- “opportunity costs”(Costs of productivity loss per day) 5- the administration of low-molecular weight heparin 6-Isolation Room 7- cost of Enoxaparin per day |
Sofia SARS Antigen FIA* = 37.96 (€) (mean cost per patients) Conventional approach = 192.21 (€) (mean cost per patients) Incremental Cost for FIA= (€) 0 Incremental Cost for Conventional approach = (€) 154.25 |
POC test is likely to reduce hospital-related costs in cases of suspected COVID-19 in German emergency departments. |
| Zafari 2021 [26] | 2020 US dollars | A decision-analytic model | $200,000 per QALY gained | Gateway testing plus CDC guidelines 0.55 (−0.16, 2.34) Weekly testing plus CDC guidelines 1.10 (0.14, 4.89) |
Gateway testing plus CDC* guidelines-$4043021 ( -$11416977,-$1863169) Weekly testing plus CDCguidelines$10235673 (-$2162557,$11062938) |
Gateway testing plus CDC guidelines( -$7398283) Weekly testing plus CDC guidelines $9273023 |
At both a prevalence of 1% and 2%, the ‘package’ intervention saved money and improved health compared to all the other interventions |
| Guzman Ruiz 2021 [27] | 2020 US dollars | A Markov simulation model | at any willingness-to-pay threshold | The social perspective: (annually) PCR: 0.44 QALY The healthcare perspective: (annually) PCR: 0.44 QALY |
The social perspective: (annually) PCR: 1045.52 The healthcare perspective: (annually) PCR: 850.19 |
social, healthcare perspective ICER: Dominates | TTI* program as implemented in Colombia represents a cost-effective use of resources, even when the costs and disutility's associated with long COVID-19 were not included. |
| Jiang 2020 [30] | CN¥ (2020) | Markov model | CN¥64644 | QALY: 850.1 QALDs:36 799 |
Two tests: 715.5 million Three tests: 666.4 million |
−49.1 million | NMB (CN¥): 104.0 million |
| López Seguí 2021 [21] | € (2021) | – | – | 251 QALY | €8,372 265 | Increase in costs: €4,609 943 Cost per QALY: €18,392 |
CBA*:1.20 |
| Maya2021 [24] | $2020 | decision model | - | Early clinical period, days 1–7: IgG* + PCR: 0.0003 Only Ag*: 0.09 IgG, if positive PCR: 1.39 No Test: 1.828 Only IgG: 1.826 |
Early clinical period, days 1–7: IgG + PCR: $404 Only Ag: $3660 IgG, if positive PCR: $59,664 No Test: $77,539 Only IgG: $77,863 |
ICER: Early clinical period, days 1–7: IgG + PCR: $1,081 393 Only Ag& IgG, if positive PCR& No Test&Only IgG: Dominated |
Early clinical period, days 1–7: Only PCR, dominant Early clinical period, days 8–14: Only PCR, $34,000/QALY gained Late clinical period: No Test, dominant Asymptomatic: Only Ag, dominant |
| Bogere 2021 [29] |
$2020 | – | - | Pooledtesting(Positive:21,Negative: 1259,Total:1280) Individual RT-PCR* testing(Positive:24 Negative:1256 Total:1280) |
pooled sample testing:16 128$ individual sample testing:71 680 $ |
55 552 US$ | pooled testing increases cost-effectiveness without much influence on the accuracy of PCR testing |
| Neilan 2021 [31] | $2020 | dynamic state-transition microsimulation model |
$100 000/QALY | Slowing scenario Symptomatic: 11 900 )Hospitalized: 16 400 Symptomatic + asymptomatic once: 10 500 Symptomatic + asymptomatic monthly: 8900 ( Intermediate scenario)Symptomatic: 18 300 Symptomatic + asymptomatic once: 16 100 Hospitalized: 36 100 Symptomatic + asymptomatic monthly: 11 400 ( Surging scenario) Symptomatic:72 600 Symptomatic + asymptomatic once: 68 800 Hospitalized:97 200 Symptomatic + asymptomatic monthly 37 700 ( |
Slowing scenario Symptomatic: 342 787 000)Hospitalized: 439 495 000 Symptomatic + asymptomatic once: 605 505 000 Symptomatic + asymptomatic monthly: 2024106000 ( Intermediate scenario)Symptomatic 488 896 000: Symptomatic + asymptomatic once: 727 290 000 Hospitalized: 849 882 000 Symptomatic + asymptomatic monthly: 2091084000 ( Surging scenario) Symptomatic: 1608128 000 Symptomatic + asymptomatic once: 1831196 000 Hospitalized: 2090289000 Symptomatic + asymptomatic monthly 2757024 000) |
Slowing scenario)Hospitalized:Dominated Symptomatic + asymptomatic once:194 000 Symptomatic + asymptomatic monthly:908 000( Intermediate scenario)Symptomatic + asymptomatic once:110 000 Hospitalized:Dominated Symptomatic + asymptomatic monthly:287 000( Surging scenario)Symptomatic + asymptomatic once: Dominated Hospitalized:Dominated Symptomatic + asymptomatic monthly:33 000( |
|
| Baggett 2021 [32] | $(2020) | decision analytic model | Re, 2.6 Symptom screening, PCR, and ACS*: 1239 Hybrid ACS: 985 Universal PCR and ACS: 1681 No intervention: 1954 Hybrid hospital: 967 Symptom screening, PCR, and hospital: 1133 Universal PCR and hospital: 1679 Universal PCR and temporary housing: 376 Re, 1.3 Symptom screening, PCR, and ACS: 137 Hybrid ACS: 103 Universal PCR and ACS: 207 No intervention: 538 Symptom screening, PCR, and hospital: 125 Hybrid hospital: 100 Universal PCR and hospital: 207 Universal PCR and temporary housing: 95 Re, 0.9 Symptom screening, PCR, and ACS: 85 No intervention: 174 Symptom screening, PCR, and hospital: 82 Universal PCR and ACS: 94 Hybrid ACS: 71 Universal PCR and hospital: 95 Hybrid hospital: 71 Universal PCR and temporary housing: 71 |
Re, 2.6 Symptom screening, PCR, and ACS: 3 267 000 Hybrid ACS: 3 628 000 Universal PCR and ACS: 4 143 000 No intervention: 6 098 000 Hybrid hospital: 12 202 000 Symptom screening, PCR, and hospital: 12 620 000 Universal PCR and hospital: 12 914 000 Universal PCR and temporary housing: 39 119 000 Re, 1.3 Symptom screening, PCR, and ACS: 409 000 Hybrid ACS: 1 325 000 Universal PCR and ACS: 1 426 000 No intervention: 1 461 000 Symptom screening, PCR, and hospital: 1 604 000 Hybrid hospital: 2 368 000 Universal PCR and hospital: 2 631 000 Universal PCR and temporary housing: 38 974 000 Re, 0.9 Symptom screening, PCR, and ACS: 264 000 No intervention: 540 000 Symptom screening, PCR, and hospital: 1 113 000 Universal PCR and ACS: 1 226 000 Hybrid ACS: 1 240 000 Universal PCR and hospital: 1 901 000 Hybrid hospital: 2 004 000 Universal PCR and temporary housing:38 954 000 |
Re, 2.6 Hybrid ACS: 1000 Universal PCR and ACS/No intervention/Hybrid hospital/Symptom screening, PCR, and hospital/Universal PCR and hospital: Dominated Universal PCR and temporary housing: 58 000 Re, 1.3 Hybrid ACS: 27 000 Universal PCR and ACS/No intervention/Symptom screening PCR, and hospital/Universal PCR and hospital: Dominated Hybrid hospital: 382 000 Universal PCR and temporary housing: 6 854 000 Re, 0.9 Hybrid ACS: 71 000 No intervention/Hybrid hospital/Symptom screening, PCR, and hospital/Universal PCR and ACS/Hybrid hospital/Universal PCR and temporary housing/Universal PCR and hospital: Dominated |
Daily symptom screening with PCR testing of individuals who had positive screening results and ACS-based COVID-19 management was cost-effectiveness compared with no intervention. |
Re: Effective Reproductive Number/HT: Health-care Testing/CT: Contact Tracing within households/IC: Isolation Centers/MS: Mass Symptom Screening/QC: Quarantine Centers/YLS:/Years of Life Saved/YLL: Years of Life Lost/ICER: Incremental Cost-Effectiveness Ratio/QALY: Quality Adjusted Life Years/POC or POCTs: Point-of-Care Tests/PCR: Polymerase Chain Reaction/NMB: Net Monetary Benefit/TPPs: Target Product Profiles/FIA: Sofia SARS Antigen/CDC: Centers for Disease Prevention and Control/TTI: Test-Trace-Isolate/CBA: Cost Benefit Analysis/IgG: Immunoglobulin G/Ag: Antigen or Rapid Antigen/RT-PCR: Real-Time Polymerase Chain Reaction/ACS: Alternative Care Site.