Benefits of routine COVID-19 testing depend on circulating variant virulence
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Key takeaways:
- The costs of COVID-19 testing in nursing homes outweighed benefits based on winter 2023-2024 conditions.
- Testing became cost-effective, however, with increasingly severe clinical outcomes.
The cost-effectiveness of routine COVID-19 testing among nursing home staff depended on the virulence of variants circulating during the time of testing, researchers found.
“[This study was prompted by the fact that] there hasn't been clear guidance as to when and how often nursing homes should test their staff for COVID-19 and how this may change as the SARS-CoV-2 virus has continued to evolve,” Bruce Y. Lee, MD, MBA, professor of health policy and management at the City University of New York Graduate School of Public Health and Health Policy, told Healio.
Studies have shown that serial testing among nursing home staff and residents has helped prevent dangerous case counts during outbreaks.
One previous study of nursing home residents and staff showed that outbreak testing had the potential to prevent between 54% and 92% of SARS-CoV-2 infections with weekly testing and a 48-hour turnaround or daily testing with immediate results, respectively. Non-outbreak testing resulted in an additional 8% of cases being prevented, depending on test frequency and result turnaround time. The researchers noted, however, that these results were taken from a time frame before vaccination and when testing supplies were limited.
Lee and colleagues wrote in the new study that since the start of the pandemic, implementation of nursing home staff testing strategies has varied, partially because the value of the strategies has not been quantified.
In order to assess when and how often nursing homes should test staff for COVID-19 and how this could change as the virus evolves, the researchers developed an agent-based model representing a typical nursing home and COVID-19 spread, as well as health and economic outcomes, to best determine the clinical and economic value of various screening and isolation strategies and how it may change under various circumstances.
Based on conditions during winter 2023-2024 as SARS-CoV-2 omicron subvariant viruses circulated in the U.S., the study demonstrated that symptom-based antigen testing averted 4.5 COVID-19 cases compared with no testing, saving $191 in direct medical costs.
The researchers said, however, that testing implementation costs “far outweighed” these savings, resulting in net costs of $990 from the CMS perspective, $1,545 from the third-party payer perspective and $57,155 from the societal perspective.
Testing remained cost-ineffective when routinely testing staff during periods of varying face mask compliance, vaccine efficacy and booster coverage — which varied as rates of vaccination among heath care workers and facility staff was called into question — however, the study also showed that all testing strategies became cost-effective ($31,906 or less per quality-adjusted life-year) or cost saving ($18,372 or less) when the severe outcome risk was 3 times or more higher than current omicron variants.
“When determining whether to routinely test nursing home staff for COVID-19, it's important to keep in mind the virulence of the SARS-CoV-2 variants that are circulating at the time,” Lee said. “The cost-effectiveness of such testing can change as the epidemic evolves because it depends on how severe the outcomes of COVID-19 may be.”
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