Free rapid antigen tests make economic sense

The federal government announced this week that around 6.6 million Australians would be eligible for up to 10 free rapid antigen tests. But as Jonathan karnon, Billie Bonevski and Hossein Haji Ali Afzali argue that a policy of government-funded rapid antigen testing for all is very likely to pay off.

Following considerable public pressure in recent weeks, the federal government has announced that concession card holders will soon be able to collect up to ten free rapid antigen tests over three months.

But everyone will continue to have to buy their own rapid antigen tests, which cost over A $ 10 per test.

In countries like Singapore, the UK, and Germany, rapid antigenic testing is free for everyone.

We have developed a model that estimates the cost-effectiveness of a government-funded rapid antigenic testing policy for all Australians. We have published our economic analysis as a pre-print online, which has not yet been independently reviewed by other researchers.

We have found that a policy of government funded rapid antigen testing for all is very likely to pay off.

Even minor reductions in COVID transmission rates due to increased early isolation would justify the additional costs associated with the policy.

Here’s why.

Why are tests so important?

Testing and contact tracing have been the main measures used to stop the spread of COVID around the world.

One of the advantages of case finding is that it allows countries to quickly identify new cases, isolate those affected and their close contacts, and thus slow the transmission of the disease.

Australia has relied on PCR (polymerase chain reaction) testing to confirm cases of COVID, which are federally funded and free to Australians.

But the emergence of the highly transmissible Omicron variant, coinciding with an easing of public health restrictions and the social holiday season, has resulted in an increase in COVID cases in Australia, inundating the PCR testing system.

Governments are moving towards using rapid antigen tests to confirm positive cases, which can give results in 15 minutes, although they are not as accurate as PCR tests.

How does our analysis work?

We have created a “decision tree” model, which represents the test pathways for a hypothetical group of people. without Symptoms of covid.

We used it to estimate the number of COVID-positive people isolated before developing symptoms.

It is essential that key people isolate themselves as soon as possible to reduce the risk of spreading to others.

We analyzed a range of possible scenarios.

A decision tree showing possible outcomes with the use or non-use of rapid antigenic tests
A “decision tree” showing test pathways for people without symptoms of COVID, but who may have COVID. Jon Karnon and his colleagues, Author provided

A key parameter is the proportion of people who use a rapid antigen test who have COVID.

Let’s play a scenario.

Let’s say a group of 10,000 people get free rapid antigen tests funded by the government. Suppose 1,000 out of 10,000 users have COVID and a rapid antigen test costs $ 10.

Suppose also that 2,000 of 10,000 would buy rapid antigen tests if they were not funded by the government. (The actual proportion who would be willing and able to purchase a rapid antigen test is impossible to know, given the current shortage.)

What did we find?

In the group where everyone had access to free rapid antigen tests, the model estimates that this policy would lead to the early isolation of an additional 464 people, compared to a group in which 20% bought their own rapid antigen tests.

Providing free rapid tests to 10,000 people would cost the government $ 100,000, but spending less on PCR tests (which cost around $ 150 each) reduces the additional costs to the government to around $ 52,000.

Rapid antigen tests are less effective in people without symptoms, so they would not catch everyone in the group who test positive for COVID.

But the net effect is preventing 464 more people from infecting more people, reducing the costs to the economy of new infections. The costs of isolating these people only after developing symptoms would likely be much higher than the additional $ 52,000 spent on testing.

Dividing the $ 52,000 by the 464 previous isolation cases gives us an estimate of the cost to the government per previously isolated additional person with COVID – $ 112. This allows us to compare alternative scenarios.

For example, if only 500 of the 10,000 government-funded rapid antigen test users had COVID, an additional 232 people would isolate early and the cost per additional person isolated earlier with COVID would be $ 328.

If only 100 of the 10,000 users have COVID, the corresponding value is $ 2,052.

The less COVID in circulation, the less effective a policy of free rapid antigenic testing for all. But even with a low prevalence, it is still very likely to be profitable.

The expected benefits of early isolation are difficult to quantify, but it can only help limit the spread of COVID and the number of people infected by each person with COVID (the reproductive number). Modeling shows that in Australia, the number of spawners increased from around 1 to 1.5 during December 2021, and daily reported COVID cases increased from around 1,000 to over 30,000. This illustrates the importance of breeding stock and the magnitude of the potential effects of increasing early isolation of people with COVID. Even a minor reduction in the number of spawners will have a significant effect on the number of daily cases.

There are high costs to health and the economy of failing to isolate people with COVID early on.

People with COVID who do not know they are HIV positive will pass it on to others, many of whom will get sick, need medical attention, and take time off work. Some will need to go to the hospital, be in intensive care and be put on a ventilator. And some will die.

A proportion of those who recover from the initial stage of infection will have persistent symptoms of the virus, known as “long COVID”.

All of these results impose significant costs on individuals and on society. We could make a conservative assumption that each early isolated case prevents at least one new case of COVID and that the wide range of costs associated with a case of COVID is much higher than the $ 112 it could cost the government per isolated person. extra early with COVID.

Are there any downsides?

One thing to consider is overuse. If people over-used rapid antigen tests, such as when people are very unlikely to have been exposed to COVID, it would reduce the profitability of the policy.

In saying that, the unpleasant nature of the testing process should limit such overuse – no one likes to stick the swab in their nose!

Hoarding is another risk, as with toilet paper at the start of the pandemic. It would therefore be important to ensure confidence in the procurement and distribution of tests.

Limiting the spread of COVID is important for many reasons, including to avoid short and long term health effects, reduce the burden on the healthcare system, and increase the availability of essential workers.

Easy and fair access to testing is the cornerstone of the public health response to COVID. It also makes economic sense.The conversation

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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