Cost-Effectiveness of Universal Asymptomatic Preoperative SARS-CoV-2 PCR Screening: A Cost-Utility Analysis

Speaker(s)

Uno S1, Goto R2, Honda K3, Uchida S1, Uwamino Y1, Namkoong H1, Yoshifuji A1, Mikita K1, Takano Y4, Matsumoto M1, Kitagawa Y1, Hasegawa N1
1Keio University, Shinjuku, Tokyo, Japan, 2Keio University, Yokohama, Japan, 3Keio University Global Research Institute, Minato, Tokyo, Japan, 4Keio University Hospital, Shinjuku, Tokyo, Japan

Presentation Documents

OBJECTIVES: An early report has shown the clinical benefit of the universal preoperative SARS-CoV-2 asymptomatic screening test (ie, asymptomatic screening) and recommended in some clinical guidelines; however, the cost-effectiveness of asymptomatic screening was not evaluated. We aimed to evaluate the cost-effectiveness of asymptomatic screening using polymerase chain reaction testing.

METHODS: We evaluated the cost-effectiveness of asymptomatic screening using a decision tree model compared with no screening option, assuming a test-positive rate of 0.07% and a screening cost of 8,500 JPY(~7,601 USD) in the base case. It was analyzed from a Japanese public health insurance payer perspective. The input parameter was derived from the best available evidence reported in the peer-reviewed literature to date. A willingness-to-pay threshold was set at 5,000,000 JPY/QALY.

RESULTS: The incremental cost was 74,469,236 JPY (~566,048 USD) of one death averted and was 291,123,368 JPY per QALY gained (~2,212,856 USD/QALY), which was above the willingness-to-pay threshold. In deterministic sensitivity analyses, the incremental cost-effectiveness ratio fell below 5,000,000 JPY/QALY only when the test-positive rate exceeded 0.739%; however, when the probability developing postoperative pulmonary complications among SARS-CoV-2 positive patients was below 0.22, asymptomatic screening was never cost-effective, regardless of the test-positive rate.

CONCLUSIONS: Asymptomatic preoperative universal SARS-CoV-2 PCR screening is not cost-effective in the base-case analysis. The cost-effectiveness depends mainly on the test-positive rate, the incidence of postoperative pulmonary complications, and the screening costs; however, if the vaccine reduced the incidence of postoperative pulmonary complications to the same level as in the pre-COVID-19 era, asymptomatic screening would not be cost-effective regardless of the test-positive rate.

Code

EE643

Topic

Economic Evaluation

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis

Disease

Infectious Disease (non-vaccine), No Additional Disease & Conditions/Specialized Treatment Areas