Cost-effectiveness of a whole-area testing pilot of asymptomatic SARS-CoV-2 infections with lateral flow devices: a modelling and economic analysis study

• Published in: BMC health services research Vol. 22; no. 1; pp. 1190 - 12
• Main Authors: Drakesmith, Mark, Collins, Brendan, Jones, Angela, Nnoaham, Kelechi, Thomas, Daniel Rhys
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 22.09.2022; BioMed Central; BMC
• Subjects: Analysis; Asymptomatic; Community testing; Coronaviruses; Cost analysis; Cost-Benefit Analysis; Cost-effectiveness; COVID-19; COVID-19 - epidemiology; COVID-19 - prevention & control; Disease transmission; Economic analysis; Economic aspects; Estimates; Health care; Health Care Costs; Health services; Humans; Infections; Lateral flow test; Mass testing; Medical care, Cost of; Medical screening; Methods; Public health; Quality-Adjusted Life Years; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; United Kingdom; United Kingdom > UK; Wales; Economic analysis; QALYs; SARS-CoV-2; Covid-19; Epidemiological modelling; Community testing; Lateral flow test; Mass testing; Cost-effectiveness
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-022-08511-3

Mass community testing for SARS-CoV-2 by lateral flow devices (LFDs) aims to reduce prevalence in the community. However its effectiveness as a public heath intervention is disputed. Data from a mass testing pilot in the Borough of Merthyr Tydfil in late 2020 was used to model cases, hospitalisations, ICU admissions and deaths prevented. Further economic analysis with a healthcare perspective assessed cost-effectiveness in terms of healthcare costs avoided and QALYs gained. An initial conservative estimate of 360 (95% CI: 311-418) cases were prevented by the mass testing, representing a would-be reduction of 11% of all cases diagnosed in Merthyr Tydfil residents during the same period. Modelling healthcare burden estimates that 24 (16-36) hospitalizations, 5 (3-6) ICU admissions and 15 (11-20) deaths were prevented, representing 6.37%, 11.1% and 8.2%, respectively of the actual counts during the same period. A less conservative, best-case scenario predicts 2333 (1764-3115) cases prevented, representing 80% reduction in would-be cases. Cost -effectiveness analysis indicates 108 (80-143) QALYs gained, an incremental cost-effectiveness ratio of £2,143 (£860-£4,175) per QALY gained and net monetary benefit of £6.2 m (£4.5 m-£8.4 m). In the best-case scenario, this increases to £15.9 m (£12.3 m-£20.5 m). A non-negligible number of cases, hospitalisations and deaths were prevented by the mass testing pilot. Considering QALYs gained and healthcare costs avoided, the pilot was cost-effective. These findings suggest mass testing with LFDs in areas of high prevalence (> 2%) is likely to provide significant public health benefit. It is not yet clear whether similar benefits will be obtained in low prevalence settings or with vaccination rollout.