Evidence map›Paper›PMID 33685466›Full record

ArticleBMC medicine2021

Quantifying the potential value of antigen-detection rapid diagnostic tests for COVID-19: a modelling analysis.

Saskia Ricks, Emily A Kendall, David W Dowdy, Jilian A Sacks, Samuel G Schumacher, Nimalan Arinaminpathy

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
35citing papers in PubMed, 4 pooled it
4.1field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

35 citing papers in PubMed, 4 syntheses or guidelines pooled it, 69 citations in OpenAlex.

  1. Pooled it
  2. Diagnostics and Treatments of COVID-19: A Living Systematic Review of Economic Evaluations.Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2022
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  17. Importance of external quality assessment for SARS-CoV-2 antigen detection during the COVID-19 pandemic.Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology · 2022
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  19. Rapid Antigen Assays for SARS-CoV-2: Promise and Peril.Clinics in laboratory medicine · 2022
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 4 institutions in 3 countries.

Saskia RicksMRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK. saskia.ricks12@imperial.ac.uk.ORCID http://orcid.org/0000-0001-7994-6111
Emily A KendallDivision of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
David W DowdyDepartment of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Jilian A SacksFoundation for Innovative New Diagnostics, Geneva, Switzerland.
Samuel G SchumacherFoundation for Innovative New Diagnostics, Geneva, Switzerland.
Nimalan ArinaminpathyMRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK.
FIND · CHJohns Hopkins University · USImperial College London · GBNIHR Imperial Biomedical Research Centre · GB

Funding

Medical Research Council MC_PC_19012Medical Research Council MR/R015600/1Wellcome TrustWellcome Trust 203839/A/16/Z
6 · The paper itself

Abstract

backgroundTesting plays a critical role in treatment and prevention responses to the COVID-19 pandemic. Compared to nucleic acid tests (NATs), antigen-detection rapid diagnostic tests (Ag-RDTs) can be more accessible, but typically have lower sensitivity and specificity. By quantifying these trade-offs, we aimed to inform decisions about when an Ag-RDT would offer greater public health value than reliance on NAT.

methodsFollowing an expert consultation, we selected two use cases for analysis: rapid identification of people with COVID-19 amongst patients admitted with respiratory symptoms in a 'hospital' setting and early identification and isolation of people with mildly symptomatic COVID-19 in a 'community' setting. Using decision analysis, we evaluated the health system cost and health impact (deaths averted and infectious days isolated) of an Ag-RDT-led strategy, compared to a strategy based on NAT and clinical judgement. We adopted a broad range of values for 'contextual' parameters relevant to a range of settings, including the availability of NAT and the performance of clinical judgement. We performed a multivariate sensitivity analysis to all of these parameters.

resultsIn a hospital setting, an Ag-RDT-led strategy would avert more deaths than a NAT-based strategy, and at lower cost per death averted, when the sensitivity of clinical judgement is less than 90%, and when NAT results are available in time to inform clinical decision-making for less than 85% of patients. The use of an Ag-RDT is robustly supported in community settings, where it would avert more transmission at lower cost than relying on NAT alone, under a wide range of assumptions.

conclusionsDespite their imperfect sensitivity and specificity, Ag-RDTs have the potential to be simultaneously more impactful, and have a lower cost per death and infectious person-days averted, than current approaches to COVID-19 diagnostic testing.

Indexed as

Antigens, ViralCOVID-19COVID-19 TestingDiagnostic Tests, RoutineHumansPandemicsSARS-CoV-2Sensitivity and SpecificityAntigens, ViralAntigenCOVID-19Rapid diagnostic tests

Identifiers

PMID33685466
PMCPMC7939929
OpenAlexW3109374438

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.