Clinical and Economic Impact of Widespread Rapid Testing to Decrease SARS-CoV-2 Transmission

Paltiel, A. David; Zheng, Amy; Sax, Paul E.

BACKGROUND: The value of frequent, rapid testing to reduce community transmission of SARS-CoV-2 is poorly understood. OBJECTIVE: To define performance standards and predict the clinical, epidemiological, and economic outcomes of nationwide, home-based, antigen testing. DESIGN: A simple compartmental epidemic model estimated viral transmission, clinical history, and resource use, with and without testing. DATA SOURCES: Parameter values and ranges informed by Centers for Disease Control guidance and published literature. TARGET POPULATION: United States population. TIME HORIZON: 60 days. PERSPECTIVE: Societal. Costs include: testing, inpatient care, and lost workdays. INTERVENTION: Home-based SARS-CoV-2 antigen testing. OUTCOME MEASURES: Cumulative infections and deaths, numbers isolated and/or hospitalized, and total costs. RESULTS OF BASE-CASE ANALYSIS: Without a testing intervention, the model anticipates 15 million infections, 125,000 deaths, and $10.4 billion in costs ($6.5 billion inpatient; $3.9 billion lost productivity) over a 60-day horizon. Weekly availability of testing may avert 4 million infections and 19,000 deaths, raising costs by $21.5 billion. Lower inpatient outlays ($5.9 billion) would partially offset additional testing expenditures ($12.0 billion) and workdays lost ($13.9 billion), yielding incremental costs per infection (death) averted of $5,400 ($1,100,000). RESULTS OF SENSITIVITY ANALYSIS: Outcome estimates vary widely under different behavioral assumptions and testing frequencies. However, key findings persist across all scenarios: large reductions in infections, mortality, and hospitalizations; and costs per death averted roughly an order of magnitude lower than commonly accepted willingness-to-pay values per statistical life saved ($5-17 million). LIMITATIONS: Analysis restricted to at-home testing and limited by uncertainties about test performance. CONCLUSION: High-frequency home testing for SARS-CoV-2 using an inexpensive, imperfect test could contribute to pandemic control at justifiable cost and warrants consideration as part of a national containment strategy.