Cost-effectiveness and Accuracy Analysis of Different Screening Strategies for COVID-19

Background: Coronavirus disease 2019 (COVID-19) is mainly confirmed through reverse transcription polymerase chain reaction (RT-PCR), which is both expensive and time-consuming and requires specific equipment. Thus, demand for rapid diagnostic methods, such as rapid antigen detection (RAD) tests, has emerged. Here, we assessed the efficiency and reliability of RAD for early diagnosis of COVID-19. Methods: We performed a retrospective study based on systemic COVID-19 screening and diagnosis using RAD and RT-PCR at Taipei City Hospital during the first COVID-19 outbreak week in Taiwan (28 May-6 June 2021). We postulated five strategies for COVID-19 screening in the general population: one RAD test, one RT-PCR test, one RAD test (negative) followed by one RT-PCR, one RAD test (positive) followed by one RT-PCR test, and two RAD tests and calculated their cost and accuracy. We also conducted a cost-effectiveness analysis to identify the most economically efficient strategy for COVID-19 diagnosis. This study included 6368 cases in total. Results: Although RAD exhibited low sensitivity (mean 66%), other values were acceptable: mean specificity, positive predictive value, negative predictive value, and accuracy were 99%, 82.8%, 97.5%, and 94.2%, respectively. RAD was the most cost-effective method. Additionally, it may be an effective diagnostic strategy in the later stages of the epidemic, warranting further research. Conclusion: Although RT-PCR remains the standard method for diagnosing COVID-19, RAD is faster and a more cost-effective, convenient, and globally available method, allowing for early detection of SARS-CoV-2.