COVID-19 testing protocols to guide duration of isolation: a cost-effectiveness analysis
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Abstract
Background
The Omicron variant of SARS-CoV-2 led to a steep rise in transmissions, and emerging variants continue to influence case rates across the US. As public tolerance for isolation abated, CDC guidance on duration of at-home isolation of COVID-19 cases was shortened to five days if no symptoms, with no laboratory test requirement, despite more cautious approaches advocated by other federal experts.
Methods
We conducted a decision tree analysis of alternative protocols for ending COVID-19 isolation, estimating net costs (direct and productivity), secondary infections, and incremental cost-effectiveness ratios. Sensitivity analyses assessed the impact of input uncertainty.
Results
Per 100 individuals, five-day isolation had 23 predicted secondary infections and a net cost of $33,000. Symptom check on day five (CDC guidance) yielded a 23% decrease in secondary infections (to 17.8), with a net cost of $45,000. Antigen testing on day six yielded 2.9 secondary infections and $63,000 in net costs. This protocol, compared to the next best protocol of antigen testing on day five of a maximum eight-day isolation, cost an additional $1,300 per secondary infection averted. Antigen or polymerase chain reaction testing on day five were dominated (more expensive and less effective) versus antigen testing on day six. Results were qualitatively robust to uncertainty in key inputs.
Conclusions
A six-day isolation with antigen testing to confirm the absence of contagious virus appears the most effective and cost-effective de-isolation protocol to shorten at-home isolation of individuals with COVID-19.
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SciScore for 10.1101/2022.03.21.22272687: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Limitations: This study had important limitations, especially regarding uncertainty in key inputs such as the viral kinetics of SARS-CoV-2 and sensitivity of antigen tests. First, we distributed Reff over the 10 days following COVID-19 confirmation, but a portion of transmissions occur prior to the index case learning their COVID-19 …
SciScore for 10.1101/2022.03.21.22272687: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Limitations: This study had important limitations, especially regarding uncertainty in key inputs such as the viral kinetics of SARS-CoV-2 and sensitivity of antigen tests. First, we distributed Reff over the 10 days following COVID-19 confirmation, but a portion of transmissions occur prior to the index case learning their COVID-19 status and entering isolation. As such, we have overestimated the number of secondary infections in our model and underestimated ICER values. Decreasing the residual R would increase ICERs but given favorable ICERs even in the low-risk scenario, we believe the implications of our findings would not be affected. More importantly, given the novelty of the Omicron variant, we had to rely on studies of prior variants for these two important factors. While variance in neither of these inputs changed cost-effectiveness results qualitatively, they did have an impact on the number of further transmissions after isolation and thus the level of cost-effectiveness. Additional studies on the viral kinetics of the Omicron variant are necessary to refine these estimates.
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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