Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., Floor 7, San Francisco, CA 94158, USA.
California Department of Public Health, Fresno, CA 95899, USA.
Int J Environ Res Public Health. 2022 Jul 30;19(15):9371. doi: 10.3390/ijerph19159371.
Public health officials must provide guidance on operating schools safely during the COVID-19 pandemic. Using data from April-December 2021, we conducted a cost-effectiveness analysis to assess six screening strategies for schools using SARS-CoV-2 antigen and PCR tests and varying screening frequencies for 1000 individuals. We estimated secondary infections averted, quality-adjusted life years (QALYs), cost per QALY gained, and unnecessary school days missed per infection averted. We conducted sensitivity analyses for the more transmissible Omicron variant. Weekly antigen testing with PCR follow-up for positives was the most cost-effective option given moderate transmission, adding 0.035 QALYs at a cost of USD 320,000 per QALY gained in the base case (R = 1.1, prevalence = 0.2%). This strategy had the fewest needlessly missed school days (ten) per secondary infection averted. During widespread community transmission with Omicron (R = 1.5, prevalence = 5.8%), twice weekly antigen testing with PCR follow-up led to 2.02 QALYs gained compared to no test and cost the least (USD 187,300), with 0.5 needlessly missed schooldays per infection averted. In periods of moderate community transmission, weekly antigen testing with PCR follow up can help reduce transmission in schools with minimal unnecessary days of school missed. During widespread community transmission, twice weekly antigen screening with PCR confirmation is the most cost-effective and efficient strategy. Schools may benefit from resources to implement routine asymptomatic testing during surges; benefits decline as community transmission declines.
公共卫生官员必须就 COVID-19 大流行期间安全运营学校提供指导。我们使用 2021 年 4 月至 12 月的数据，进行了一项成本效益分析，以评估使用 SARS-CoV-2 抗原和 PCR 检测以及不同筛查频率对 1000 人的六种筛查策略。我们估计了可避免的二次感染、质量调整生命年（QALY）、每获得一个 QALY 的成本以及每避免一次感染而错过的不必要的上学日数。我们对更具传染性的奥密克戎变异株进行了敏感性分析。在中度传播的情况下，每周进行抗原检测并对阳性结果进行 PCR 随访是最具成本效益的选择，在基本情况下每获得一个 QALY 的成本为 32 万美元（R = 1.1，患病率 = 0.2%），增加了 0.035 个 QALY。这种策略避免了每个继发感染所导致的不必要的缺课日数（10 天）最少。在奥密克戎广泛社区传播期间（R = 1.5，患病率 = 5.8%），与不进行检测相比，每周进行两次抗原检测并进行 PCR 随访可获得 2.02 个 QALY，成本最低（187300 美元），避免每个感染的不必要缺课日数为 0.5 天。在中度社区传播期间，每周进行抗原检测并进行 PCR 随访有助于减少学校传播，同时将不必要的缺课日数降到最低。在广泛的社区传播期间，每周两次抗原筛查并进行 PCR 确认是最具成本效益和效率的策略。在疫情高峰期，学校可以从资源中受益，实施常规的无症状检测；随着社区传播的减少，收益也会下降。
