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. 2022 Sep 22;22(1):1190.
doi: 10.1186/s12913-022-08511-3.

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

Mark Drakesmith  1 , Brendan Collins  2   3 , Angela Jones  4 , Kelechi Nnoaham  4 , Daniel Rhys Thomas  5   6
Affiliations

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

Mark Drakesmith et al. BMC Health Serv Res. .

Abstract

Background: 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.

Method: 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.

Results: 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).

Conclusions: 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.

Keywords: Community testing; Cost-effectiveness; Covid-19; Economic analysis; Epidemiological modelling; Lateral flow test; Mass testing; QALYs; SARS-CoV-2.

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Conflict of interest statement

All authors declare no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years. Dr Collins is seconded as Head of Health Economics in Welsh Government, this paper does not represent any views of Welsh Government.

Figures

Fig. 1
Fig. 1
Flowchart of process for (a) estimating number of cases detected by mass testing that would not otherwise be detected and for (b) estimating number of cases prevented, and other healthcare outcomes. This process is followed iteratively for each day in the testing period
Fig. 2
Fig. 2
a Estimated Rt in Merthyr Tydfil over the testing period. b Positive lateral flow test results from community testing pilot in Merthyr Tydfil, with estimates for true positives and proportion remaining asymptomatic. Note that missing data in the weekend of 11th to 13th December is due to temporary suspension of the mass testing on these dates. c Daily estimates of 1st generation and 2nd + higher generation infections prevented
Fig. 3
Fig. 3
Estimates of hospitalizations, ICU admissions and deaths prevented from cases prevented by mass testing
See this image and copyright information in PMC

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