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COVID-19 testing protocols to guide duration of isolation: a cost-effectiveness analysis
1Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St, Box 0936, 95158, San Francisco, CA, USA. Sigal.Maya@ucsf.edu.
BMC Public Health
|May 11, 2023
Summary
A six-day COVID-19 isolation period with antigen testing is the most effective strategy to reduce secondary infections and costs. This approach balances public health needs with economic considerations for ending at-home isolation.
Area of Science:
- Epidemiology
- Public Health Policy
- Health Economics
Background:
- The emergence of SARS-CoV-2 variants, including Omicron, has driven significant transmission waves across the US.
- Public willingness to adhere to prolonged isolation decreased, prompting revised guidance.
- The Centers for Disease Control and Prevention (CDC) shortened COVID-19 isolation to five days without mandatory testing, diverging from some expert recommendations.
Purpose of the Study:
- To analyze the cost-effectiveness of various COVID-19 at-home isolation protocols.
- To compare secondary infection rates and economic impacts of different de-isolation strategies.
- To identify optimal protocols for ending isolation based on scientific and economic data.
Main Methods:
- Decision tree analysis was employed to model alternative COVID-19 isolation protocols.
- Net costs, including direct expenses and productivity losses, were estimated.
- Secondary infections and incremental cost-effectiveness ratios (ICERs) were calculated, with sensitivity analyses performed.
Main Results:
- A five-day isolation resulted in 23 secondary infections per 100 individuals at a cost of $33,000.
- Symptom-based, five-day isolation (CDC guidance) reduced infections to 17.8 but increased costs to $45,000.
- A six-day isolation with antigen testing yielded only 2.9 secondary infections at a cost of $63,000, proving highly effective.
Conclusions:
- A six-day isolation period incorporating antigen testing to confirm non-contagiousness is the most effective and cost-efficient de-isolation strategy.
- This protocol offers a significant reduction in secondary infections compared to shorter, symptom-based approaches.
- The findings support a data-driven approach to optimizing COVID-19 isolation guidelines.
