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COVID-19 polymerase chain reaction testing before endoscopy: an economic analysis. | LitMetric

AI Article Synopsis

  • The COVID-19 pandemic drastically reduced endoscopy procedures, prompting a study on integrating PCR testing to safely resume these practices.
  • A retrospective analysis compared three strategies for endoscopy utilization: urgent-only procedures, semiurgent testing, and testing all patients, focusing on their effectiveness and costs amidst varying COVID-19 prevalence.
  • Results showed that strategies involving testing allowed for a significant increase in procedures done, with PCR testing emerging as a vital approach to restarting endoscopic services safely while considering both economic and health impacts.

Article Abstract

Background And Aims: The novel coronavirus disease 2019 (COVID-19) pandemic has limited endoscopy utilization, causing significant health and economic losses. We aim to model the impact of polymerase chain reaction (PCR) testing into resuming endoscopy practice.

Methods: We performed a retrospective review of endoscopy utilization during the COVID-19 pandemic for a baseline reference. A computer model compared 3 approaches: strategy 1, endoscopy for urgent indications only; strategy 2, testing for semiurgent indications; and strategy 3, testing all patients. Analysis was made under current COVID-19 prevalence and projected prevalence of 5% and 10%. Primary outcomes were number of procedures performed and/or canceled. Secondary outcomes were direct costs, reimbursement, personal protective equipment used, and personnel infected. Disease prevalence, testing accuracy, and costs were obtained from the literature.

Results: During the COVID-19 pandemic, endoscopy volume was 12.7% of expected. Strategies 2 and 3 were safe and effective interventions to resume endoscopy in semiurgent and elective cases. Investing 22 U.S. dollars (USD) and 105 USD in testing per patient allowed the completion of 19.4% and 95.3% of baseline endoscopies, respectively. False-negative results were seen after testing 4700 patients (or 3 months of applying strategy 2 in our practice). Implementing PCR testing over 1 week in the United States would require 13 and 64 million USD, with a return of 165 and 767 million USD to providers, leaving 65 and 325 healthcare workers infected.

Conclusions: PCR testing is an effective strategy to restart endoscopic practice in the United States. PCR screening should be implemented during the second phase of the pandemic, once the healthcare system is able to test and isolate all suspected COVID-19 cases.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7187877PMC
http://dx.doi.org/10.1016/j.gie.2020.04.049DOI Listing

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