Cost-effective proactive testing strategies during COVID-19 mass vaccination: A modelling study

Cost Effective Proactive Testing Strategies During COVID-19 Mass Vaccination: A Modelling Study

SSRN Electronic Journal ◽

10.2139/ssrn.3878074 ◽

2021 ◽

Author(s):

Zhanwei Du ◽

Lin Wang ◽

Yuan Bai ◽

Xutong Wang ◽

Abhishek Pandey ◽

...

Keyword(s):

Cost Effective ◽

Mass Vaccination ◽

Testing Strategies ◽

Modelling Study

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Harnessing testing strategies and public health measures to avert COVID-19 outbreaks during ocean cruises

Scientific Reports ◽

10.1038/s41598-021-95032-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Gerardo Chowell ◽

Sushma Dahal ◽

Raquel Bono ◽

Kenji Mizumoto

Keyword(s):

Public Health ◽

Cost Effective ◽

Contact Network ◽

Social Distancing ◽

Individual Level ◽

Health Measures ◽

Testing Strategies ◽

Novel Coronavirus ◽

The Individual ◽

The Impact

AbstractTo ensure the safe operation of schools, workplaces, nursing homes, and other businesses during COVID-19 pandemic there is an urgent need to develop cost-effective public health strategies. Here we focus on the cruise industry which was hit early by the COVID-19 pandemic, with more than 40 cruise ships reporting COVID-19 infections. We apply mathematical modeling to assess the impact of testing strategies together with social distancing protocols on the spread of the novel coronavirus during ocean cruises using an individual-level stochastic model of the transmission dynamics of COVID-19. We model the contact network, the potential importation of cases arising during shore excursions, the temporal course of infectivity at the individual level, the effects of social distancing strategies, different testing scenarios characterized by the test’s sensitivity profile, and testing frequency. Our findings indicate that PCR testing at embarkation and daily testing of all individuals aboard, together with increased social distancing and other public health measures, should allow for rapid detection and isolation of COVID-19 infections and dramatically reducing the probability of onboard COVID-19 community spread. In contrast, relying only on PCR testing at embarkation would not be sufficient to avert outbreaks, even when implementing substantial levels of social distancing measures.

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The Cost-effectiveness of Human Immunodeficiency Virus (HIV) Preexposure Prophylaxis and HIV Testing Strategies in High-risk Groups in India

Clinical Infectious Diseases ◽

10.1093/cid/ciz249 ◽

2019 ◽

Vol 70 (4) ◽

pp. 633-642 ◽

Cited By ~ 1

Author(s):

Pooyan Kazemian ◽

Sydney Costantini ◽

Nagalingeswaran Kumarasamy ◽

A David Paltiel ◽

Kenneth H Mayer ◽

...

Keyword(s):

Cost Effectiveness ◽

Hiv Testing ◽

Scale Up ◽

Cost Effective ◽

Status Quo ◽

Hiv Incidence ◽

Testing Strategies ◽

Preexposure Prophylaxis ◽

Immunodeficiency Virus ◽

The Cost

Abstract Background The human immunodeficiency virus (HIV) epidemic in India is concentrated among 3.1 million men who have sex with men (MSM) and 1.1 million people who inject drugs (PWID), with a mean incidence of 0.9–1.4 per 100 person-years. We examined the cost-effectiveness of both preexposure prophylaxis (PrEP) and HIV testing strategies for MSM and PWID in India. Methods We populated an HIV microsimulation model with India-specific data and projected clinical and economic outcomes of 7 strategies for MSM/PWID, including status quo; a 1-time HIV test; routine HIV testing every 3, 6, or 12 months; and PrEP with HIV testing every 3 or 6 months. We used a willingness-to-pay threshold of US$1950, the 2017 Indian per capita gross domestic product, to define cost-effectiveness. Results HIV testing alone increased life expectancy by 0.07–0.30 years in MSM; PrEP added approximately 0.90 life-years to status quo. Results were similar in PWID. PrEP with 6-month testing was cost-effective for both MSM (incremental cost-effectiveness ratio [ICER], $1000/year of life saved [YLS]) and PWID (ICER, $500/YLS). Results were most sensitive to HIV incidence. PrEP with 6-month testing would increase HIV-related expenditures by US$708 million (MSM) and US$218 million (PWID) over 5 years compared to status quo. Conclusions While the World Health Organization recommends PrEP with quarterly HIV testing, our analysis identifies PrEP with semiannual testing as the cost-effective HIV prevention strategy for Indian MSM and PWID. Since nationwide scale-up would require a substantial fiscal investment, areas of highest HIV incidence may be the appropriate initial targets for PrEP scale-up.

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Universal Mass Vaccination With Phid-Cv Is Cost-Effective In Croatia

Value in Health ◽

10.1016/j.jval.2016.09.387 ◽

2016 ◽

Vol 19 (7) ◽

pp. A413

Author(s):

G Bencina ◽

J Olbrecht

Keyword(s):

Cost Effective ◽

Mass Vaccination ◽

Universal Mass Vaccination

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Microscopic examination of Gram-stained smears for anogenital gonorrhoea in men who have sex with men is cost-effective: evidence from a modelling study

Sexually Transmitted Infections ◽

10.1136/sextrans-2018-053578 ◽

2018 ◽

Vol 95 (1) ◽

pp. 13-20 ◽

Cited By ~ 2

Author(s):

Jolijn M Zwart ◽

Marie-Josee J Mangen ◽

Menne Bartelsman ◽

Martijn S van Rooijen ◽

Henry J C de Vries ◽

...

Keyword(s):

Cost Effectiveness ◽

Cost Effective ◽

Nucleic Acid Amplification ◽

Sensitivity Analyses ◽

Transmission Model ◽

Uncertainty Interval ◽

Testing Strategies ◽

Life Years ◽

Additional Costs ◽

Sex With Men

ObjectiveTo assess the cost-effectiveness of three testing strategies with or without light microscopic Gram-stained smear (GSS) evaluation for the detection of anogenital gonorrhoea among men who have sex with men (MSM) at the Amsterdam STI clinic using a healthcare payer perspective.MethodsThree testing strategies for MSM were compared: (1) GSS in symptomatic MSM only (currently practised strategy), (2) no GSS and (3) GSS in symptomatic and asymptomatic MSM. The three testing protocols include testing with nucleic acid amplification test to verify the GSS results in (1) and (3), or as the only test in (2). A transmission model was employed to calculate the influence of the testing strategies on the prevalence of anogenital gonorrhoea over 10 years. An economic model combined cost data on medical consultations, tests and treatment and utility data to estimate the number of epididymitis cases and quality-adjusted life years (QALY) associated with gonorrhoea. Incremental cost-effectiveness ratios (ICERs) for the testing scenarios were estimated. Uncertainty and sensitivity analyses were performed.ResultsNo GSS testing compared with GSS in symptomatic MSM only (current strategy) resulted in nine extra epididymitis cases (95% uncertainty interval (UI): 2–22), 72 QALYs lost (95% UI: 59–187) and €7300 additional costs (95% UI: −€185 000 (i.e.cost-saving) to €407 000) over 10 years. GSS testing in both symptomatic and asymptomatic MSM compared with GSS in symptomatic MSM only resulted in one prevented epididymitis case (95% UI: 0–2), 1.1 QALY gained (95% UI: 0.1–3.3), €148 000 additional costs (95% UI: €86 000 to–€217 000) and an ICER of €177 000 (95% UI: €67 000–to €705 000) per QALY gained over 10 years. The results were robust in sensitivity analyses.ConclusionsGSS for symptomatic MSM only is cost-effective compared with no GSS for MSM and with GSS for both symptomatic and asymptomatic MSM.

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Comparison of molecular testing strategies for COVID-19 control: a mathematical modelling study

The Lancet Infectious Diseases ◽

10.1016/s1473-3099(20)30630-7 ◽

2020 ◽

Vol 20 (12) ◽

pp. 1381-1389 ◽

Cited By ~ 14

Author(s):

Nicholas C Grassly ◽

Margarita Pons-Salort ◽

Edward P K Parker ◽

Peter J White ◽

Neil M Ferguson ◽

...

Keyword(s):

Mathematical Modelling ◽

Molecular Testing ◽

Testing Strategies ◽

Modelling Study

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Detecting hereditary nonpolyposis colorectal cancer syndrome (HNPCC) in patients with colorectal cancer (CRC): Optimal strategies at lower costs.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.396 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 396-396 ◽

Cited By ~ 1

Author(s):

Daniel Erik Abbott ◽

Scott B. Cantor ◽

Miguel A. Rodriguez-Bigas ◽

George J. Chang ◽

Patrick M Lynch ◽

...

Keyword(s):

Colorectal Cancer ◽

Optimal Strategies ◽

Cost Effective ◽

Cancer Syndrome ◽

Dna Mismatch ◽

Testing Strategies ◽

Hereditary Nonpolyposis ◽

Protein Expressions ◽

Patient Table ◽

List Prices

396 Background: The optimal strategy to detect HNPCC in CRC pts remains controversial, and may include testing tumors for microsatellite (MSI) status and/or pts for mutations in DNA mismatch repair (MMR) genes. Costs of 6 testing strategies were compared against their risks of missing pt managed as HNPCC. Methods: 185 consecutive CRCs were prospectively tested by both immunohistochemistry (IHC, for protein expressions of MLH1, MSH2, MSH6, PMS2) and PCR-based MSI. Secondary tests included MLH1 promoter methylation, BRAF mutation, and germline mutation, as appropriate. A decision tree compared the strategy of performing both IHC and MSI in all (Strategy 1) to five alternatives (Strategies 2-6, Table ). Costs were obtained from commercial list prices, Medicare reimbursement, and literature; probabilities were calculated from pt data. Incremental cost-effectiveness ratios (ICERs) were reported for each additional pt managed as HNPCC Results: 20 (10.8%) pts were identified as being managed as HNPCC. Performing IHC and MSI in all (Strategy 1) or IHC first in all followed by MSI when IHC was normal (Strategy 4) detected all 20 cases. When compared to performing IHC only (Strategy 2), Strategy 4 demonstrated an ICER of $31,821 per additional case detected, while other strategies were more costly and/or less effective (Table). Between the two strategies that detected all cases of HNPCC, Strategy 4 was less costly ($1,049 vs $1,098 per patient, Table). Conclusions: When combined with appropriate secondary and confirmatory testing, performing IHC and MSI in all or IHC in all followed by MSI when IHC were normal, both showed a zero miss rate, while the latter was slightly more cost-effective. [Table: see text]

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Immunohistochemistry Versus Microsatellite Instability Testing in Phenotyping Colorectal Tumors

Journal of Clinical Oncology ◽

10.1200/jco.2002.20.4.1043 ◽

2002 ◽

Vol 20 (4) ◽

pp. 1043-1048 ◽

Cited By ~ 232

Author(s):

Noralane M. Lindor ◽

Lawrence J. Burgart ◽

Olga Leontovich ◽

Richard M. Goldberg ◽

Julie M. Cunningham ◽

...

Keyword(s):

Microsatellite Instability ◽

Mismatch Repair ◽

Predictive Value ◽

Dna Mismatch Repair ◽

Cost Effective ◽

Colorectal Tumors ◽

Dna Mismatch ◽

Testing Strategies ◽

Repair Deficiency ◽

Dna Mismatch Repair Deficiency

PURPOSE: To compare microsatellite instability (MSI) testing with immunohistochemical (IHC) detection of hMLH1 and hMSH2 in colorectal cancer. PATIENTS AND METHODS: Colorectal cancers from 1,144 patients were assessed for DNA mismatch repair deficiency by two methods: MSI testing and IHC detection of hMLH1 and hMSH2 gene products. High-frequency MSI (MSI-H) was defined as more than 30% instability of at least five markers; low-level MSI (MSI-L) was defined as 1% to 29% of loci unstable. RESULTS: Of 1,144 tumors tested, 818 showed intact expression of hMLH1 and hMSH2. Of these, 680 were microsatellite stable (MSS), 27 were MSI-H, and 111 were MSI-L. In all, 228 tumors showed absence of hMLH1 expression and 98 showed absence of hMSH2 expression: all were MSI-H. CONCLUSION: IHC in colorectal tumors for protein products hMLH1 and hMSH2 provides a rapid, cost-effective, sensitive (92.3%), and extremely specific (100%) method for screening for DNA mismatch repair defects. The predictive value of normal IHC for an MSS/MSI-L phenotype was 96.7%, and the predictive value of abnormal IHC was 100% for an MSI-H phenotype. Testing strategies must take into account acceptability of missing some cases of MSI-H tumors if only IHC is performed.

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