Clinical and Economic Impact of Widespread Rapid Testing to Decrease SARS-CoV-2 Transmission (preprint)

ABSTRACT

BackgroundThe value of frequent, rapid testing to reduce community transmission of SARS-CoV-2 is poorly understood. ObjectiveTo define performance standards and predict the clinical, epidemiological, and economic outcomes of nationwide, home-based, antigen testing. DesignA simple compartmental epidemic model estimated viral transmission, clinical history, and resource use, with and without testing. Data SourcesParameter values and ranges informed by Centers for Disease Control guidance and published literature. Target PopulationUnited States population. Time Horizon60 days. PerspectiveSocietal.Costs include testing, inpatient care, and lost workdays. InterventionHome-based SARS-CoV-2 antigen testing. Outcome MeasuresCumulative infections and deaths, numbers isolated and/or hospitalized, and total costs. Results of Base-Case AnalysisWithout a testing intervention, the model anticipates 15 million infections, 125,000 deaths, and $10.4 billion in costs ($6.5 billion inpatient; $3.9 billion lost productivity) over a 60-day horizon. Weekly availability of testing may avert 4 million infections and 19,000 deaths, raising costs by $21.5 billion. Lower inpatient outlays ($5.9 billion) would partially offset additional testing expenditures ($12.0 billion) and workdays lost ($13.9 billion), yielding incremental costs per infection (death) averted of $5,400 ($1,100,000). Results of Sensitivity AnalysisOutcome estimates vary widely under different behavioral assumptions and testing frequencies. However, key findings persist across all scenarios large reductions in infections, mortality, and hospitalizations; and costs per death averted roughly an order of magnitude lower than commonly accepted willingness-to-pay values per statistical life saved ($5-17 million). LimitationsAnalysis restricted to at-home testing and limited by uncertainties about test performance. ConclusionHigh-frequency home testing for SARS-CoV-2 using an inexpensive, imperfect test could contribute to pandemic control at justifiable cost and warrants consideration as part of a national containment strategy. Primary Funding SourcesDr. Paltiel was supported by grant R37DA015612 from the National Institute on Drug Abuse of the National Institutes of Health. Dr. Sax was supported by grant R01AI042006 from the National Institute of Allergy and Infectious Diseases of the National Institutes of Health.