Point-of-care COVID-19 antigen testing in German emergency rooms - a cost-benefit analysis

Abstract

Background: The current COVID-19 pandemic is causing significant morbidity and death worldwide and produces significant socio-economic losses.

Objective: To assess the cost-benefit relation of implementing point-of-care COVID-19 antigen testing (POCT) in emergency rooms (ER) of German hospitals.

Methods: A deterministic decision-analytic model simulated the incremental costs of using the Sofia® SARS Antigen FIA test compared to those of using clinical judgement alone to confirm or exclude COVID-19 in adult patients in German ER, prior to hospitalization. Direct and indirect costs, with and without subsequent RT-PCR confirmation, were evaluated from the hospital perspective.

Results: With respect to ER patients, in base-case analysis, considering a COVID-19 prevalence of 15.6% and a hospitalization rate among COVID-19 suspects of 10.1%, POCT testing reduces average costs of hospitalized patients by €213 per tested patient if nasopharyngeal swabs of patients suspected to have COVID-19 are also sent to external labs for RT-PCR testing. In probabilistic sensitivity analysis, under all reasonable assumptions, implementing the Sofia® SARS Antigen FIA saves on average about €210 as compared to applying the clinical-judgement-only strategy. The major part of cost savings, €159 or 75.9%, is due to the POC test´s high specificity resulting in a 21-fold lower proportion of unnecessary bed blocking at the first day of hospitalization.

Conclusions: Using highly specific rapid COVID-19 tests in COVID-19 suspects at German ER, despite of their sub-optimal sensitivity, may significantly reduce hospital expenditure.

Keywords: Antigen testing; COVID-19; Cost-benefit analysis; Point-of-care; Real-time reverse transcriptase polymerase chain reaction (RT-PCR); SARS-CoV-2.

Fig. 1

Point-of-Care antigen testing (POCT) versus the conventional approach in COVID-19 suspects prior to hospitalization Legend to Fig. 1:A decision node (square) indicates a choice facing the decision maker or the consequences of a decision. Branches from a chance node (circles) represent the possible outcomes of an event; terminal nodes (triangles) denote the endpoints of a scenario and are assigned the costs of a prior series of actions and events. The arrows in the decision notes pointing downwards demonstrate that the optimal path of the model is that with the lowest total cost. ER: Emergency room; POCT: Point-of-Care antigen testing; RT-PCR: Reverse Transcriptase-PCR; COVID_prev: Prevalence of COVID-19 [reference 3 (Supplement)], Sofia_COVID_sens: Real life sensitivity of Sofia test [reference 12 (Supplement)]: Sofia_Covid_spec: Real life specificity of Sofia testing [reference 12 (Supplement)]; Clin_sens_COVID: Sensitivity of diagnosing SARS-CoV-2 infection [reference 8 (Supplement)]; Clin_spec_COVID: Probability of correctly excluding SARS-CoV-2 [reference 8 (Supplement)]. #: Complementary probability (all probabilities of chance node's branches to sum to 1.0); +: positive; -: negative.