Cost-Effectiveness of Universal Asymptomatic Preoperative SARS-CoV-2 Polymerase Chain Reaction Screening: A Cost-Utility Analysis

Shunsuke Uno; Rei Goto; Kimiko Honda; Sho Uchida; Yoshifumi Uwamino; Ho Namkoong; Ayumi Yoshifuji; Kei Mikita; Yaoko Takano; Morio Matsumoto; Yuko Kitagawa; Naoki Hasegawa

doi:10.1093/cid/ciad463

Cost-Effectiveness of Universal Asymptomatic Preoperative SARS-CoV-2 Polymerase Chain Reaction Screening: A Cost-Utility Analysis

Clin Infect Dis. 2024 Jan 25;78(1):57-64. doi: 10.1093/cid/ciad463.

Authors

Shunsuke Uno^{1

2}, Rei Goto^{2

3

4}, Kimiko Honda^{2

4

5}, Sho Uchida¹, Yoshifumi Uwamino⁶, Ho Namkoong¹, Ayumi Yoshifuji¹, Kei Mikita¹, Yaoko Takano⁷, Morio Matsumoto⁸, Yuko Kitagawa⁹, Naoki Hasegawa¹

Affiliations

¹ Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan.
² Health Technology Assessment Unit, Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan.
³ Graduate School of Business Administration, Keio University, Kanagawa, Japan.
⁴ Graduate School of Health Management, Keio University, Kanagawa, Japan.
⁵ Center of Health Economics and Health Technology Assessment, Keio University Global Research Institute, Tokyo, Japan.
⁶ Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan.
⁷ Division of Infectious Diseases and Infection Control, Keio University Hospital, Tokyo, Japan.
⁸ Department of Orthopedics, Keio University School of Medicine, Tokyo, Japan.
⁹ Department of Surgery, Keio University School of Medicine, Tokyo, Japan.

Abstract

Background: An early report has shown the clinical benefit of the asymptomatic preoperative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) screening test, and some clinical guidelines recommended this test. However, the cost-effectiveness of asymptomatic screening was not evaluated. We aimed to investigate the cost-effectiveness of universal preoperative screening of asymptomatic patients for SARS-CoV-2 using polymerase chain reaction (PCR) testing.

Methods: We evaluated the cost-effectiveness of asymptomatic screening using a decision tree model from a payer perspective, assuming that the test-positive rate was 0.07% and the screening cost was 8500 Japanese yen (JPY) (approximately 7601 US dollars [USD]). The input parameter was derived from the available evidence reported in the literature. A willingness-to-pay threshold was set at 5 000 000 JPY/quality-adjusted life-year (QALY).

Results: The incremental cost of 1 death averted was 74 469 236 JPY (approximately 566 048 USD) and 291 123 368 JPY/QALY (approximately 2 212 856 USD/QALY), which was above the 5 000 000 JPY/QALY willingness-to-pay threshold. 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 of developing a postoperative pulmonary complication among SARS-CoV-2-positive patients was below 0.22, asymptomatic screening was never cost-effective, regardless of how high the test-positive rate became.

Conclusions: Asymptomatic preoperative universal SARS-CoV-2 PCR screening is not cost-effective in the base case analysis. The cost-effectiveness mainly depends on the test-positive rate, the frequency of postoperative pulmonary complications, and the screening costs; however, no matter how high the test-positive rate, the cost-effectiveness is poor if the probability of developing postoperative pulmonary complications among patients positive for SARS-CoV-2 is sufficiently reduced.

Keywords: COVID-19; cost-effectiveness; polymerase chain reaction; preoperative; universal asymptomatic screening.

MeSH terms

COVID-19 Testing
COVID-19* / diagnosis
Cost-Benefit Analysis
Humans
Polymerase Chain Reaction
Quality-Adjusted Life Years
SARS-CoV-2*