Objective: Nursing home (NH) residents may be particularly vulnerable to COVID-19. Therefore, a question is when and how often NHs should test staff for COVID-19 and how this may change as COVID-19 evolves. Design: We developed an agent-based model representing a typical NH, COVID-19 spread, and its health and economic outcomes to determine the clinical and economic value of various screening and isolation strategies and how it may change under various circumstances. Results: Under Winter 2023–2024 Omicron variant conditions, symptom-based antigen testing averted 4.5 COVID-19 cases compared to no testing, saving $191 in direct medical costs. Testing implementation costs far outweighed these savings, resulting in a net cost of $990, $1,545, and $57,155 from the Centers for Medicare & Medicaid Services, third-party payer, and societal perspectives, respectively. Testing did not return sufficient positive health effects to make it cost-effective ($50,000/quality-adjusted life-year threshold), exceeding this threshold in ≥59% of simulation trials. Testing remained not cost-effective when routinely testing staff and varying face mask compliance, vaccine efficacy, and booster coverage. However, all antigen testing strategies became cost-effective (≤$31,906/quality-adjusted life-year) or cost saving (≤$18,372,) when the severe outcome risk was ≥3 times higher than current Omicron variants. Conclusions: COVID-19 testing costs outweigh benefits under Winter 2023–2024 conditions; however, testing becomes cost-effective with increasingly severe clinical outcomes. Cost-effectiveness can change as the epidemic evolves since it depends on clinical severity and other intervention use, highlighting the need for NH administrators and policymakers to monitor and evaluate viral virulence and other interventions over time.
【저자키워드】 COVID-19, SARS-CoV-2, Testing, cost-effectiveness, nursing homes, economic,