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Screening Strategies to Reduce COVID-19 Mortality in Nursing Homes
Shirley Dong1, Eric Jutkowitz1,2,3, John Giardina4
1Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island.
JAMA Health Forum
|April 26, 2024
Summary
This study found that regular COVID-19 screening in nursing homes is cost-effective for reducing deaths, especially during high community transmission or low booster uptake. These findings help administrators plan effective interventions.
Area of Science:
- Public Health
- Epidemiology
- Health Economics
Background:
- Nursing home residents face disproportionately high COVID-19 morbidity and mortality.
- Despite comprising 0.4% of the US population, they accounted for 9% of COVID-19 deaths in 2023.
Purpose of the Study:
- To evaluate the cost-effectiveness of different COVID-19 screening strategies in nursing homes.
- To identify optimal screening frequencies to reduce mortality.
Main Methods:
- An agent-based model simulated SARS-CoV-2 transmission in a typical US nursing home.
- Parameters were informed by data from CMS, CDC, and nursing home studies (2010-2023).
- Simulations varied screening frequency (none, weekly, twice-weekly) against community incidence, booster uptake, and antiviral use.
Main Results:
- Cost-effectiveness ratios for weekly/twice-weekly screening were under $150,000 per life-year gained at moderate to high community COVID-19 incidence with varying booster uptake.
- Antiviral use at 100% increased cost-effectiveness ratios above $150,000 per life-year when booster uptake was low and community incidence was high.
Conclusions:
- COVID-19 screening in nursing homes can be cost-effective in reducing mortality, particularly when community incidence is high or booster uptake is low.
- Findings provide guidance for nursing home administrators managing SARS-CoV-2 transmission and interventions.
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