养老院严重急性呼吸道冠状病毒 2 (SARS-CoV-2) 检测和隔离策略的成本效益。

IF 3 4区 医学 Q2 INFECTIOUS DISEASES
Infection Control and Hospital Epidemiology Pub Date : 2024-06-01 Epub Date: 2024-02-15 DOI:10.1017/ice.2024.9
Sarah M Bartsch, Colleen Weatherwax, Marie F Martinez, Kevin L Chin, Michael R Wasserman, Raveena D Singh, Jessie L Heneghan, Gabrielle M Gussin, Sheryl A Scannell, Cameron White, Bruce Leff, Susan S Huang, Bruce Y Lee
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引用次数: 0

摘要

目的:养老院居民可能特别容易感染 2019 年冠状病毒病(COVID-19)。因此,一个问题是养老院应在何时、多长时间对员工进行 COVID-19 检测,以及随着严重急性呼吸道冠状病毒 2(SARS-CoV-2)的发展,这一问题可能会发生怎样的变化:我们开发了一个基于代理的模型,该模型代表了典型的疗养院、COVID-19 的传播及其健康和经济结果,以确定各种筛查和隔离策略的临床和经济价值,以及在各种情况下可能发生的变化:结果:在 2023-2024 年冬季 SARS-CoV-2 omicron 变异条件下,与不进行检测相比,基于症状的抗原检测可避免 4.5 例 COVID-19 病例,节省直接医疗费用 191 美元。检测的实施成本远远超过了节省的费用,从医疗保险与医疗补助服务中心的角度看,净成本为 990 美元,从第三方支付者的角度看,净成本为 1545 美元,从社会角度看,净成本为 57155 美元。检测并没有带来足够的积极健康效应,因而不具备成本效益[每质量调整生命年(QALY)阈值为 50,000 美元],但在≥59% 的模拟试验中,检测的成本效益超过了这一阈值。如果对员工进行常规检测,并改变面罩依从性、疫苗效力和强化覆盖率,检测仍然不具成本效益。然而,当严重后果风险比目前的 omicron 变异株高出≥3 倍时,所有抗原检测策略都具有成本效益(每 QALY ≤31,906 美元)或节约成本(节约成本≤18,372 美元):结论:在 2023-2024 年冬季条件下,SARS-CoV-2 检测成本大于收益;然而,随着临床结果越来越严重,检测变得越来越具有成本效益。成本效益会随着疫情的发展而变化,因为它取决于临床严重程度和其他干预措施的使用情况。因此,养老院管理者和政策制定者应随着时间的推移对病毒毒性和其他干预措施进行监测和评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Cost-effectiveness of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) testing and isolation strategies in nursing homes.

Objective: Nursing home residents may be particularly vulnerable to coronavirus disease 2019 (COVID-19). Therefore, a question is when and how often nursing homes should test staff for COVID-19 and how this may change as severe acute respiratory coronavirus virus 2 (SARS-CoV-2) evolves.

Design: We developed an agent-based model representing a typical nursing home, COVID-19 spread, and its health and economic outcomes to determine the clinical and economic value of various screening and isolation strategies and how it may change under various circumstances.

Results: Under winter 2023-2024 SARS-CoV-2 omicron variant conditions, symptom-based antigen testing averted 4.5 COVID-19 cases compared to no testing, saving $191 in direct medical costs. Testing implementation costs far outweighed these savings, resulting in net costs of $990 from the Centers for Medicare & Medicaid Services perspective, $1,545 from the third-party payer perspective, and $57,155 from the societal perspective. Testing did not return sufficient positive health effects to make it cost-effective [$50,000 per quality-adjusted life-year (QALY) threshold], but it exceeded this threshold in ≥59% of simulation trials. Testing remained cost-ineffective when routinely testing staff and varying face mask compliance, vaccine efficacy, and booster coverage. However, all antigen testing strategies became cost-effective (≤$31,906 per QALY) or cost saving (saving ≤$18,372) when the severe outcome risk was ≥3 times higher than that of current omicron variants.

Conclusions: SARS-CoV-2 testing costs outweighed benefits under winter 2023-2024 conditions; however, testing became cost-effective with increasingly severe clinical outcomes. Cost-effectiveness can change as the epidemic evolves because it depends on clinical severity and other intervention use. Thus, nursing home administrators and policy makers should monitor and evaluate viral virulence and other interventions over time.

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来源期刊
CiteScore
6.40
自引率
6.70%
发文量
289
审稿时长
3-8 weeks
期刊介绍: Infection Control and Hospital Epidemiology provides original, peer-reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. Written by infection control practitioners and epidemiologists and guided by an editorial board composed of the nation''s leaders in the field, ICHE provides a critical forum for this vital information.
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