COVID-19 polymerase chain reaction testing before endoscopy: an economic analysis

Corral, Juan E.; Hoogenboom, Sanne A.; Kröner, Paul T.; Vazquez-Roque, Maria I.; Picco, Michael F.; Farraye, Francis A.; Wallace, Michael B.

Abstract Background and Aims The COVID-19 pandemic has limited endoscopy utilization, causing significant health and economic losses. We aim to model the impact of PCR testing into resuming endoscopy practice. Methods We performed a retrospective review of endoscopy utilization during the COVID-19 pandemic for a baseline reference. A computer model compared 3 approaches―Strategy 1: endoscopy for urgent indications only; Strategy 2: testing for semi-urgent indications; and Strategy 3: testing all patients. Analysis was made under current COVID-19 prevalence, and projected prevalence of 5% and 10%. Primary outcomes were number of procedures performed/cancelled. Secondary outcomes were direct costs, reimbursement, personal protective equipment used and personnel infected. Disease prevalence, testing accuracy, and costs were obtained from literature. Results During the COVID-19 pandemic, endoscopy volume was 12.7% of expected. Strategy 2 and 3 were safe and effective interventions to resume endoscopy in semi-urgent and elective cases. Investing 22USD and 105USD in testing per patient allowed completing 19.4% and 95.3% of baseline endoscopies respectively. False negative results were seen after testing 4,700 patients (or 3 months applying Strategy 2 in our practice). Implementing PCR testing over 1 week in United States would require 13 and 64 million USD, with a return of 165 and 767 million USD to providers, leaving 65 and 325 health care workers infected. Conclusion PCR testing is an effective strategy to restart endoscopic practice in United States. PCR screening should be implemented during the second phase of the pandemic, once the healthcare system is able to test and isolate all suspected COVID-19 cases.