Low-cost, Repeat COVID-19 Testing Would Decrease Cases, Hospitalizations and Deaths

To date, the federal government has not developed a national testing strategy for COVID-19. Yet projections based on test results are essential to planning utilization of limited resources, such as hospital beds.

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Pooyan Kazemian, PhD, formerly a research scientist in the Division of General Internal Medicine, and Andrea L. Ciaranello, MD, MPH, and Anne M. Neilan, MD, MPH, infectious disease specialists working in the Medical Practice Evaluation Center at Massachusetts General Hospital, and colleagues used computer modeling to examine the impact of various COVID-19 testing strategies in Massachusetts. Among their findings, reported in Clinical Infectious Diseases, was that expanding reverse transcription polymerase chain reaction (PCR) testing to asymptomatic people would decrease infections, deaths and hospitalizations.

Study Methods

New COVID-19 infections in Massachusetts peaked in late April 2020. The researchers projected what the epidemic would be in Massachusetts from May 1 to November 1, 2020, under three growth scenarios:

• Slowing—same growth as in May, after Massachusetts announced a stay-at-home advisory and non-essential businesses closed
• Intermediate—modest increase in epidemic growth
• Surging—case numbers similar to those in late March/early April in Massachusetts

The team modeled four PCR testing strategies for all 6.9 million state residents (excluding those in long-term care facilities):

1. Testing only hospitalized patients (the "Hospitalized" strategy)
2. Strategy (a) plus testing of people with any COVID-19–consistent symptoms, who isolated if results were positive ("Symptomatic")
3. Strategy (b) plus one-time testing of the entire population ("Symptomatic+asymptomatic–once")
4. Strategy (c) plus retesting every 30 days of those who tested negative and remained asymptomatic ("Symptomatic+asymptomatic–monthly")

The article describes the model's structure, inputs and key assumptions in detail.

Clinical Outcomes

• In all epidemic growth scenarios, the expanded testing strategies reduced infections and deaths compared with Hospitalized
• In all scenarios, Symptomatic+asymptomatic–monthly led to the fewest infections, hospitalizations and deaths

Resource Utilization and Costs

In all scenarios, Symptomatic led to lower total costs than Hospitalized (test kits, bed use and lost productivity from being hospitalized or isolating).

Cost-effectiveness

• Under all scenarios, Symptomatic was cost-saving compared with Hospitalized
• Symptomatic+asymptomatic–monthly was more cost-effective than Symptomatic in the surging scenario
• Under surge or near-surge conditions, screening the entire population only one time was an inefficient strategy unless there was repeat screening for people testing negative
• In all scenarios, it was cost-effective or cost-saving to offer repeat testing as long as it cost $5 per test or less

Conclusions

The variable clinical sensitivity of PCR testing for COVID-19 would not be an issue if tests could be low-cost and frequent. Expanded testing can be expected to reduce infections by increasing the isolation of infectious people, thereby reducing hospitalizations and deaths.

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Learn more about the Medical Practice Evaluation Center at Mass General