Optimal strategies to screen health care workers for COVID-19 in the US: a cost-effectiveness analysis

Abstract

Background: Transmission of SARS-CoV-2 in health care facilities poses a challenge against pandemic control. Health care workers (HCWs) have frequent and high-risk interactions with COVID-19 patients. We undertook a cost-effectiveness analysis to determine optimal testing strategies for screening HCWs to inform strategic decision-making in health care settings.

Methods: We modeled the number of new infections, quality-adjusted life years lost, and net costs related to six testing strategies including no tests. We applied our model to four strata of HCWs, defined by the presence and timing of symptoms. We conducted sensitivity analyses to account for uncertainty in inputs.

Results: When screening recently symptomatic HCWs, conducting only a PCR test is preferable; it saves costs and improves health outcomes in the first week post-symptom onset, and costs $83,000 per quality-adjusted life year gained in the second week post-symptom onset. When screening HCWs in the late clinical disease stage, none of the testing approaches is cost-effective and thus no testing is preferable, yielding $11 and 0.003 new infections per 10 HCWs. For screening asymptomatic HCWs, antigen testing is preferable to PCR testing due to its lower cost.

Conclusions: Both PCR and antigen testing are beneficial strategies to identify infected HCWs and reduce transmission of SARS-CoV-2 in health care settings. IgG testing clinical value depends on test timing and immunity characteristics, however is not cost-effective in a low prevalence setting. As the context of the pandemic evolves, our study provides insight to health-care decision makers to keep the health care workforce safe and transmissions low.

Figure 1

Clinical status of HCWs based on existence of respiratory symptoms at time of screening [–24].

Figure 2

Probability distribution of QALYs saved with Ag vs. PCR-only testing in early clinical disease, days 1-7. PCR screening saves more QALYs than Ag testing in 74% of simulations.

Figure 3

Probability distribution of difference in net costs with Ag vs. PCR-only testing in early clinical disease, days 1-7. PCR screening has fewer net costs than Ag testing in 26% of simulations.

Figure 4

One-way sensitivity analyses on net costs of no test vs. Ag testing among asymptomatic HCWs. Inputs ranked by effect on output mean.