Cost-effectiveness of SARS-CoV-2 self-testing at routine gatherings to minimize community-level infections in lower-middle income countries: A mathematical modeling study
Places of worship serve as a venue for both mass and routine gathering around the world, and therefore are associated with risk of large-scale SARS-CoV-2 transmission. However, such routine gatherings also offer an opportunity to distribute self-tests to members of the community to potentially help...
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| Veröffentlicht in: | PloS one 2024-10, Vol.19 (10), p.e0311198 |
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| creator | Hansen, Megan A Han, Alvin X Chevalier, Joshua M Klock, Ethan Pandithakoralage, Hiromi Nooy, Alexandra de Ockhuisen, Tom Girdwood, Sarah J Lekodeba, Nkgomeleng A Khan, Shaukat Jenkins, Helen E Johnson, Cheryl C Sacks, Jilian A Russell, Colin A Nichols, Brooke E |
| description | Places of worship serve as a venue for both mass and routine gathering around the world, and therefore are associated with risk of large-scale SARS-CoV-2 transmission. However, such routine gatherings also offer an opportunity to distribute self-tests to members of the community to potentially help mitigate transmission and reduce broader community spread of SARS-CoV-2. Over the past four years, self-testing strategies have been an impactful tool for countries' response to the COVID-19 pandemic, especially early on to mitigate the spread when vaccination and treatment options were limited. We used an agent-based mathematical model to estimate the impact of various strategies of symptomatic and asymptomatic self-testing for a fixed percentage of weekly routine gatherings at places of worship on community transmission of SARS-CoV-2 in Brazil, Georgia, and Zambia. Testing strategies assessed included weekly and bi-weekly self-testing across varying levels of vaccine effectiveness, vaccine coverage, and reproductive numbers to simulate developing stages of the COVID-19 pandemic. Self-testing symptomatic people attending routine gatherings can cost-effectively reduce the spread of SARS-CoV-2 within places of worship and the community, resulting in incremental cost-effectiveness ratios of $69-$303 USD. This trend is especially true in contexts where population level attendance at such gatherings is high, demonstrating that a distribution approach is more impactful when a greater proportion of the population is reached. Asymptomatic self-testing of attendees at 100% of places of worship in a country results in the greatest percent of infections averted and is consistently cost-effective but remains costly. Budgetary needs for asymptomatic testing are expensive and likely unaffordable for lower-middle income countries (520-1550x greater than that of symptomatic testing alone), promoting that strategies to strengthen symptomatic testing should remain a higher priority. |
| doi_str_mv | 10.1371/journal.pone.0311198 |
| format | Article |
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However, such routine gatherings also offer an opportunity to distribute self-tests to members of the community to potentially help mitigate transmission and reduce broader community spread of SARS-CoV-2. Over the past four years, self-testing strategies have been an impactful tool for countries' response to the COVID-19 pandemic, especially early on to mitigate the spread when vaccination and treatment options were limited. We used an agent-based mathematical model to estimate the impact of various strategies of symptomatic and asymptomatic self-testing for a fixed percentage of weekly routine gatherings at places of worship on community transmission of SARS-CoV-2 in Brazil, Georgia, and Zambia. Testing strategies assessed included weekly and bi-weekly self-testing across varying levels of vaccine effectiveness, vaccine coverage, and reproductive numbers to simulate developing stages of the COVID-19 pandemic. Self-testing symptomatic people attending routine gatherings can cost-effectively reduce the spread of SARS-CoV-2 within places of worship and the community, resulting in incremental cost-effectiveness ratios of $69-$303 USD. This trend is especially true in contexts where population level attendance at such gatherings is high, demonstrating that a distribution approach is more impactful when a greater proportion of the population is reached. Asymptomatic self-testing of attendees at 100% of places of worship in a country results in the greatest percent of infections averted and is consistently cost-effective but remains costly. Budgetary needs for asymptomatic testing are expensive and likely unaffordable for lower-middle income countries (520-1550x greater than that of symptomatic testing alone), promoting that strategies to strengthen symptomatic testing should remain a higher priority.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0311198</identifier><identifier>PMID: 39365802</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Analysis ; Asymptomatic ; Brazil - epidemiology ; Community health services ; Cost analysis ; Cost effectiveness ; Cost-Benefit Analysis ; COVID-19 ; COVID-19 - diagnosis ; COVID-19 - economics ; COVID-19 - epidemiology ; COVID-19 - prevention & control ; COVID-19 - transmission ; COVID-19 diagnostic tests ; COVID-19 Testing - economics ; COVID-19 Testing - methods ; COVID-19 vaccines ; Developing Countries ; Disease transmission ; Distribution costs ; Evaluation ; Hepatitis C ; HIV ; Households ; Human immunodeficiency virus ; Humans ; Infection control ; Infections ; Management ; Mass Gatherings ; Mathematical models ; Medical care, Cost of ; Methods ; Models, Theoretical ; Pandemics ; Population ; Religion ; SARS-CoV-2 - isolation & purification ; Self testing ; Severe acute respiratory syndrome coronavirus 2 ; Vaccine efficacy ; Vaccines ; Zambia - epidemiology</subject><ispartof>PloS one, 2024-10, Vol.19 (10), p.e0311198</ispartof><rights>Copyright: © 2024 Hansen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</rights><rights>COPYRIGHT 2024 Public Library of Science</rights><rights>2024 Hansen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2024 Hansen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c409t-8f28024473123b7719257b48647251bbc0bbafe97fd21a1126c30675797b0ac33</cites><orcidid>0009-0007-0003-7179 ; 0000-0003-4682-4999</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0311198&type=printable$$EPDF$$P50$$Gplos$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0311198$$EHTML$$P50$$Gplos$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,860,2096,2915,23845,27901,27902,79569,79570</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39365802$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hansen, Megan A</creatorcontrib><creatorcontrib>Han, Alvin X</creatorcontrib><creatorcontrib>Chevalier, Joshua M</creatorcontrib><creatorcontrib>Klock, Ethan</creatorcontrib><creatorcontrib>Pandithakoralage, Hiromi</creatorcontrib><creatorcontrib>Nooy, Alexandra de</creatorcontrib><creatorcontrib>Ockhuisen, Tom</creatorcontrib><creatorcontrib>Girdwood, Sarah J</creatorcontrib><creatorcontrib>Lekodeba, Nkgomeleng A</creatorcontrib><creatorcontrib>Khan, Shaukat</creatorcontrib><creatorcontrib>Jenkins, Helen E</creatorcontrib><creatorcontrib>Johnson, Cheryl C</creatorcontrib><creatorcontrib>Sacks, Jilian A</creatorcontrib><creatorcontrib>Russell, Colin A</creatorcontrib><creatorcontrib>Nichols, Brooke E</creatorcontrib><title>Cost-effectiveness of SARS-CoV-2 self-testing at routine gatherings to minimize community-level infections in lower-middle income countries: A mathematical modeling study</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Places of worship serve as a venue for both mass and routine gathering around the world, and therefore are associated with risk of large-scale SARS-CoV-2 transmission. However, such routine gatherings also offer an opportunity to distribute self-tests to members of the community to potentially help mitigate transmission and reduce broader community spread of SARS-CoV-2. Over the past four years, self-testing strategies have been an impactful tool for countries' response to the COVID-19 pandemic, especially early on to mitigate the spread when vaccination and treatment options were limited. We used an agent-based mathematical model to estimate the impact of various strategies of symptomatic and asymptomatic self-testing for a fixed percentage of weekly routine gatherings at places of worship on community transmission of SARS-CoV-2 in Brazil, Georgia, and Zambia. Testing strategies assessed included weekly and bi-weekly self-testing across varying levels of vaccine effectiveness, vaccine coverage, and reproductive numbers to simulate developing stages of the COVID-19 pandemic. Self-testing symptomatic people attending routine gatherings can cost-effectively reduce the spread of SARS-CoV-2 within places of worship and the community, resulting in incremental cost-effectiveness ratios of $69-$303 USD. This trend is especially true in contexts where population level attendance at such gatherings is high, demonstrating that a distribution approach is more impactful when a greater proportion of the population is reached. Asymptomatic self-testing of attendees at 100% of places of worship in a country results in the greatest percent of infections averted and is consistently cost-effective but remains costly. Budgetary needs for asymptomatic testing are expensive and likely unaffordable for lower-middle income countries (520-1550x greater than that of symptomatic testing alone), promoting that strategies to strengthen symptomatic testing should remain a higher priority.</description><subject>Analysis</subject><subject>Asymptomatic</subject><subject>Brazil - epidemiology</subject><subject>Community health services</subject><subject>Cost analysis</subject><subject>Cost effectiveness</subject><subject>Cost-Benefit Analysis</subject><subject>COVID-19</subject><subject>COVID-19 - diagnosis</subject><subject>COVID-19 - economics</subject><subject>COVID-19 - epidemiology</subject><subject>COVID-19 - prevention & control</subject><subject>COVID-19 - transmission</subject><subject>COVID-19 diagnostic tests</subject><subject>COVID-19 Testing - economics</subject><subject>COVID-19 Testing - methods</subject><subject>COVID-19 vaccines</subject><subject>Developing Countries</subject><subject>Disease transmission</subject><subject>Distribution costs</subject><subject>Evaluation</subject><subject>Hepatitis C</subject><subject>HIV</subject><subject>Households</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Infection control</subject><subject>Infections</subject><subject>Management</subject><subject>Mass Gatherings</subject><subject>Mathematical models</subject><subject>Medical care, Cost of</subject><subject>Methods</subject><subject>Models, Theoretical</subject><subject>Pandemics</subject><subject>Population</subject><subject>Religion</subject><subject>SARS-CoV-2 - 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Academic</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hansen, Megan A</au><au>Han, Alvin X</au><au>Chevalier, Joshua M</au><au>Klock, Ethan</au><au>Pandithakoralage, Hiromi</au><au>Nooy, Alexandra de</au><au>Ockhuisen, Tom</au><au>Girdwood, Sarah J</au><au>Lekodeba, Nkgomeleng A</au><au>Khan, Shaukat</au><au>Jenkins, Helen E</au><au>Johnson, Cheryl C</au><au>Sacks, Jilian A</au><au>Russell, Colin A</au><au>Nichols, Brooke E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cost-effectiveness of SARS-CoV-2 self-testing at routine gatherings to minimize community-level infections in lower-middle income countries: A mathematical modeling study</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2024-10-04</date><risdate>2024</risdate><volume>19</volume><issue>10</issue><spage>e0311198</spage><pages>e0311198-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Places of worship serve as a venue for both mass and routine gathering around the world, and therefore are associated with risk of large-scale SARS-CoV-2 transmission. However, such routine gatherings also offer an opportunity to distribute self-tests to members of the community to potentially help mitigate transmission and reduce broader community spread of SARS-CoV-2. Over the past four years, self-testing strategies have been an impactful tool for countries' response to the COVID-19 pandemic, especially early on to mitigate the spread when vaccination and treatment options were limited. We used an agent-based mathematical model to estimate the impact of various strategies of symptomatic and asymptomatic self-testing for a fixed percentage of weekly routine gatherings at places of worship on community transmission of SARS-CoV-2 in Brazil, Georgia, and Zambia. Testing strategies assessed included weekly and bi-weekly self-testing across varying levels of vaccine effectiveness, vaccine coverage, and reproductive numbers to simulate developing stages of the COVID-19 pandemic. Self-testing symptomatic people attending routine gatherings can cost-effectively reduce the spread of SARS-CoV-2 within places of worship and the community, resulting in incremental cost-effectiveness ratios of $69-$303 USD. This trend is especially true in contexts where population level attendance at such gatherings is high, demonstrating that a distribution approach is more impactful when a greater proportion of the population is reached. Asymptomatic self-testing of attendees at 100% of places of worship in a country results in the greatest percent of infections averted and is consistently cost-effective but remains costly. Budgetary needs for asymptomatic testing are expensive and likely unaffordable for lower-middle income countries (520-1550x greater than that of symptomatic testing alone), promoting that strategies to strengthen symptomatic testing should remain a higher priority.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>39365802</pmid><doi>10.1371/journal.pone.0311198</doi><orcidid>https://orcid.org/0009-0007-0003-7179</orcidid><orcidid>https://orcid.org/0000-0003-4682-4999</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2024-10, Vol.19 (10), p.e0311198 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_3113065118 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Analysis Asymptomatic Brazil - epidemiology Community health services Cost analysis Cost effectiveness Cost-Benefit Analysis COVID-19 COVID-19 - diagnosis COVID-19 - economics COVID-19 - epidemiology COVID-19 - prevention & control COVID-19 - transmission COVID-19 diagnostic tests COVID-19 Testing - economics COVID-19 Testing - methods COVID-19 vaccines Developing Countries Disease transmission Distribution costs Evaluation Hepatitis C HIV Households Human immunodeficiency virus Humans Infection control Infections Management Mass Gatherings Mathematical models Medical care, Cost of Methods Models, Theoretical Pandemics Population Religion SARS-CoV-2 - isolation & purification Self testing Severe acute respiratory syndrome coronavirus 2 Vaccine efficacy Vaccines Zambia - epidemiology |
| title | Cost-effectiveness of SARS-CoV-2 self-testing at routine gatherings to minimize community-level infections in lower-middle income countries: A mathematical modeling study |
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