Impact and Cost-Effectiveness of Covid-19 Rapid Self-Testing Strategies in Schools

ABSTRACT

Background: Despite widespread vaccination and increasing population immunity from previous infections, community transmission of COVID-19 continues, and testing may continue to be an important component of our response particularly with the proliferation of new variants of concern. Strategic deployment of SARS-CoV-2 antigen-detection rapid diagnostic (AgRDT) self-tests to settings with increased transmission potential can reduce the viral burden within the specific settings, such as in K-12 schools, and may have spillover benefits for broader community transmission. Method(s) Using a previously developed agent-based simulation model, parameterized to three distinct country archetypes (Brazil, Georgia, Zambia), we analyzed 11 different self-testing strategies within the school-going population at three testing frequencies under 24 different epidemic conditions (Rt, vaccination coverage/effectiveness), comprising a total of 696 scenarios per country. Strategies included symptomatic testing, and in addition, asymptomatic testing at 5, 20, 40 or 100% of schools, or asymptomatic contact testing. These were all targeted to either only teachers or teachers and students. Then, with the cost to offer a COVID-19 self-test in schools at USD 2.50, we performed an economic analysis with all scenarios to identify the most costeffective strategies by country. Result(s) Routine asymptomatic testing of teachers and students at 100% of schools reduced the greatest number of infections across contexts, but at the greatest cost. However, with respect to both the reduction in infections and total cost, symptomatic testing of all teachers and students appears to be the most efficient strategy. Symptomatic testing can prevent up to 69.3%, 64.5%, and 75.5% of school infections in Brazil, Georgia, and Zambia, across all epidemic conditions. Additionally, it can prevent up to 77,200, 80,900, 107,800 symptomatic days per 100,000 teachers and students in each country, respectively, over the course of a 90-day epidemic wave. The incremental cost-effectiveness ratios for strategies that consistently appeared on the costeffectiveness frontier across countries and epidemic conditions are shown in Figure 1 for an Rt of 1.2. Conclusion(s) If financial resources are limited, symptomatic testing of teachers and students has the potential to be cost-effective while reducing a substantial number of infections and the amount of time lost from the classroom, making it a feasible strategy for implementation in a variety of settings.