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The costs of an expanded screening criteria for COVID-19: A modelling study

OBJECTIVES: Nosocomial infection is an ongoing concern in the COVID-19 outbreak. The effective screening of suspected cases in the healthcare setting is therefore necessary, enabling the early identification and prompt isolation of cases for epidemic containment. We aimed to assess the cost and heal...

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Autores principales: Lim, Jue Tao, Dickens, Borame L., Cook, Alex R., Khoo, Ai Leng, Dan, Yock Young, Fisher, Dale Andrew, Tambyah, Paul Anantharajah, Chai, Louis Yi Ann
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7422907/
https://www.ncbi.nlm.nih.gov/pubmed/32800857
http://dx.doi.org/10.1016/j.ijid.2020.08.025
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author Lim, Jue Tao
Dickens, Borame L.
Cook, Alex R.
Khoo, Ai Leng
Dan, Yock Young
Fisher, Dale Andrew
Tambyah, Paul Anantharajah
Chai, Louis Yi Ann
author_facet Lim, Jue Tao
Dickens, Borame L.
Cook, Alex R.
Khoo, Ai Leng
Dan, Yock Young
Fisher, Dale Andrew
Tambyah, Paul Anantharajah
Chai, Louis Yi Ann
author_sort Lim, Jue Tao
collection PubMed
description OBJECTIVES: Nosocomial infection is an ongoing concern in the COVID-19 outbreak. The effective screening of suspected cases in the healthcare setting is therefore necessary, enabling the early identification and prompt isolation of cases for epidemic containment. We aimed to assess the cost and health outcomes of an extended screening strategy, implemented in Singapore on 07 February 2020, which maximizes case identification in the public healthcare system. METHODS: We explored the effects of the expanded screening criteria which allow clinicians to isolate and investigate patients presenting with undifferentiated fever or respiratory symptoms or chest x-ray abnormalities. We formulated a cost appraisal framework which evaluated the treatment costs averted from the prevention of secondary transmission in the hospital setting, as determined by a branching process infection model, and compared these to the costs of the additional testing required to meet the criteria. RESULTS: In the base case analysis, an [Formula: see text] of 2.5 and incubation period of 4 days, an estimated 239 (95% CI: 201–287) cases could be averted over 150 days within the hospital setting through ESC. A corresponding $2.36 (2–2.85) million USD in costs could be averted with net cost savings of $124,000 (95% CI: −334,000 to 516,000). In the sensitivity analyses, when positive identification rates (PIR) were above 7%, regardless of [Formula: see text] and incubation period, all scenarios were cost-saving. CONCLUSION: The expanded screening criteria can help to identify and promptly isolate positive COVID cases in a cost-saving manner or within acceptable cost margins where the costs incurred from the testing of negative patients could be negated by the averted costs. Outbreak control must be sustainable and effective; the proposed screening criteria should be considered to mitigate nosocomial transmission risk within healthcare facilities.
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spelling pubmed-74229072020-08-13 The costs of an expanded screening criteria for COVID-19: A modelling study Lim, Jue Tao Dickens, Borame L. Cook, Alex R. Khoo, Ai Leng Dan, Yock Young Fisher, Dale Andrew Tambyah, Paul Anantharajah Chai, Louis Yi Ann Int J Infect Dis Article OBJECTIVES: Nosocomial infection is an ongoing concern in the COVID-19 outbreak. The effective screening of suspected cases in the healthcare setting is therefore necessary, enabling the early identification and prompt isolation of cases for epidemic containment. We aimed to assess the cost and health outcomes of an extended screening strategy, implemented in Singapore on 07 February 2020, which maximizes case identification in the public healthcare system. METHODS: We explored the effects of the expanded screening criteria which allow clinicians to isolate and investigate patients presenting with undifferentiated fever or respiratory symptoms or chest x-ray abnormalities. We formulated a cost appraisal framework which evaluated the treatment costs averted from the prevention of secondary transmission in the hospital setting, as determined by a branching process infection model, and compared these to the costs of the additional testing required to meet the criteria. RESULTS: In the base case analysis, an [Formula: see text] of 2.5 and incubation period of 4 days, an estimated 239 (95% CI: 201–287) cases could be averted over 150 days within the hospital setting through ESC. A corresponding $2.36 (2–2.85) million USD in costs could be averted with net cost savings of $124,000 (95% CI: −334,000 to 516,000). In the sensitivity analyses, when positive identification rates (PIR) were above 7%, regardless of [Formula: see text] and incubation period, all scenarios were cost-saving. CONCLUSION: The expanded screening criteria can help to identify and promptly isolate positive COVID cases in a cost-saving manner or within acceptable cost margins where the costs incurred from the testing of negative patients could be negated by the averted costs. Outbreak control must be sustainable and effective; the proposed screening criteria should be considered to mitigate nosocomial transmission risk within healthcare facilities. The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. 2020-11 2020-08-12 /pmc/articles/PMC7422907/ /pubmed/32800857 http://dx.doi.org/10.1016/j.ijid.2020.08.025 Text en © 2020 The Author(s) Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Article
Lim, Jue Tao
Dickens, Borame L.
Cook, Alex R.
Khoo, Ai Leng
Dan, Yock Young
Fisher, Dale Andrew
Tambyah, Paul Anantharajah
Chai, Louis Yi Ann
The costs of an expanded screening criteria for COVID-19: A modelling study
title The costs of an expanded screening criteria for COVID-19: A modelling study
title_full The costs of an expanded screening criteria for COVID-19: A modelling study
title_fullStr The costs of an expanded screening criteria for COVID-19: A modelling study
title_full_unstemmed The costs of an expanded screening criteria for COVID-19: A modelling study
title_short The costs of an expanded screening criteria for COVID-19: A modelling study
title_sort costs of an expanded screening criteria for covid-19: a modelling study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7422907/
https://www.ncbi.nlm.nih.gov/pubmed/32800857
http://dx.doi.org/10.1016/j.ijid.2020.08.025
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