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COVID-19 polymerase chain reaction testing before endoscopy: an economic analysis
Juan E Corral1, Sanne A Hoogenboom1, Paul T Kröner1
1Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA.
Gastrointestinal Endoscopy
|May 4, 2020
Summary
Polymerase chain reaction (PCR) testing can safely resume endoscopy practices impacted by COVID-19. Implementing PCR screening allows for a significant increase in procedures, offering economic benefits while managing healthcare worker infections.
Area of Science:
- Gastroenterology
- Infectious Disease Epidemiology
- Health Economics
Background:
- The COVID-19 pandemic severely restricted endoscopy utilization, leading to substantial health and economic consequences.
- Resuming endoscopic procedures is crucial for patient care and healthcare system function.
- Modeling the impact of polymerase chain reaction (PCR) testing offers a strategy to mitigate pandemic-related disruptions.
Purpose of the Study:
- To model the impact of integrating polymerase chain reaction (PCR) testing into endoscopy practice to facilitate its resumption.
- To compare different PCR testing strategies for their safety, effectiveness, and economic viability.
- To assess the potential for increasing endoscopy volumes while minimizing risks during the COVID-19 pandemic.
Main Methods:
- A retrospective review of endoscopy utilization during the COVID-19 pandemic established a baseline.
- A computer model evaluated three strategies: urgent cases only, semiurgent cases with testing, and all cases with testing.
- Analysis considered current and projected COVID-19 prevalence, testing accuracy, and costs.
Main Results:
- Endoscopy volume dropped to 12.7% of expected during the pandemic.
- PCR testing strategies for semiurgent and elective cases proved safe and effective, enabling 19.4% and 95.3% of baseline procedures, respectively.
- Implementing PCR testing nationwide could require significant investment but yield substantial returns, with projected healthcare worker infections.
Conclusions:
- Polymerase chain reaction (PCR) testing is a viable and effective strategy for restarting endoscopic practices in the United States.
- PCR screening should be implemented during the second phase of the pandemic, contingent on robust healthcare system capacity for testing and isolation.
- Strategic PCR testing balances the need to resume essential medical procedures with the imperative to control viral transmission.
