ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2021
Clinical Impact, Costs, and Cost-effectiveness of Expanded Severe Acute Respiratory Syndrome Coronavirus 2 Testing in Massachusetts.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 47 papers, 6 of them syntheses that pooled it.
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47 citing papers in PubMed, 6 syntheses or guidelines pooled it.
- Economic Evaluation of COVID-19 Screening Tests and Surveillance Strategies in Low-Income, Middle-Income, and High-Income Countries: A Systematic Review.Medical science monitor : international medical journal of experimental and clinical research · 2024Pooled it
- Cost of the COVID-19 pandemic versus the cost-effectiveness of mitigation strategies in EU/UK/OECD: a systematic review.BMJ open · 2023Pooled it
- Economic evaluation of laboratory diagnostic test types in Covid-19 epidemic: A systematic review.International journal of surgery (London, England) · 2022Pooled it
- Cost-effectiveness of interventions for the prevention and control of COVID-19: Systematic review of 85 modelling studies.Journal of global health · 2022Pooled it
- Cost-Effectiveness of COVID-19 Policy Measures: A Systematic Review.Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2021Pooled it
- Economic evaluation of programs against COVID-19: A systematic review.International journal of surgery (London, England) · 2021Pooled it
- Effects of behavioral intervention components to increase COVID-19 testing for African American/Black and Latine frontline essential workers not up-to-date on COVID-19 vaccination: Results of an optimization randomized controlled trial.Journal of behavioral medicine · 2025Trial
- Economic evaluation of wastewater surveillance in Ontario, Canada, using COVID-19 as a case study.Canada communicable disease report = Releve des maladies transmissibles au Canada · 2026Article
- Economic Analyses of COVID-19 Interventions: A Narrative Review of Global Evidence.Healthcare (Basel, Switzerland) · 2025Review
- Health and Economic Impact of COVID-19 Surveillance Testing in Seattle Homeless Shelters: A Cost-Effectiveness Analysis.AJPM focus · 2025Article
- Enhanced testing can substantially improve defense against several types of respiratory virus pandemic.Epidemics · 2025Article
- Article
- The role of economic evaluation in modelling public health and social measures for pandemic policy: a systematic review.Cost effectiveness and resource allocation : C/E · 2024Article
- Surveillance strategies for the detection of new pathogen variants across epidemiological contexts.PLoS computational biology · 2024Article
- Using simulation modeling to inform intervention and implementation selection in a rapid stakeholder-engaged hybrid effectiveness-implementation randomized trial.Implementation science communications · 2024Article
- Epidemiological and health economic implications of symptom propagation in respiratory pathogens: A mathematical modelling investigation.PLoS computational biology · 2024Article
- Mitigating the COVID-19 Pandemic through Data-Driven Resource Sharing.Naval research logistics · 2024Article
- Mitigation through on-site testing & education among formerly incarcerated individuals against Covid-19 - The MOSAIC study: Design and rationale.Contemporary clinical trials · 2024Article
- A population-based study of the trend in SARS-CoV-2 diagnostic modalities from the beginning of the pandemic to the Omicron surge in Kyoto City, Kyoto, Japan.BMC public health · 2023Observational
- Economic Evaluation of Wastewater Surveillance Combined with Clinical COVID-19 Screening Tests, Japan.Emerging infectious diseases · 2023Article
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Abstract
backgroundWe projected the clinical and economic impact of alternative testing strategies on coronavirus disease 2019 (COVID-19) incidence and mortality in Massachusetts using a microsimulation model.
methodsWe compared 4 testing strategies: (1) hospitalized: polymerase chain reaction (PCR) testing only for patients with severe/critical symptoms warranting hospitalization; (2) symptomatic: PCR for any COVID-19-consistent symptoms, with self-isolation if positive; (3) symptomatic + asymptomatic once: symptomatic and 1-time PCR for the entire population; and (4) symptomatic + asymptomatic monthly: symptomatic with monthly retesting for the entire population. We examined effective reproduction numbers (Re = 0.9-2.0) at which policy conclusions would change. We assumed homogeneous mixing among the Massachusetts population (excluding those residing in long-term care facilities). We used published data on disease progression and mortality, transmission, PCR sensitivity/specificity (70%/100%), and costs. Model-projected outcomes included infections, deaths, tests performed, hospital-days, and costs over 180 days, as well as incremental cost-effectiveness ratios (ICERs, $/quality-adjusted life-year [QALY]).
resultsAt Re = 0.9, symptomatic + asymptomatic monthly vs hospitalized resulted in a 64% reduction in infections and a 46% reduction in deaths, but required >66-fold more tests/day with 5-fold higher costs. Symptomatic + asymptomatic monthly had an ICER <$100 000/QALY only when Re ≥1.6; when test cost was ≤$3, every 14-day testing was cost-effective at all Re examined.
conclusionsTesting people with any COVID-19-consistent symptoms would be cost-saving compared to testing only those whose symptoms warrant hospital care. Expanding PCR testing to asymptomatic people would decrease infections, deaths, and hospitalizations. Despite modest sensitivity, low-cost, repeat screening of the entire population could be cost-effective in all epidemic settings.
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