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The cost-effectiveness of conducting three versus two reverse transcription-polymerase chain reaction tests for diagnosing and discharging people with COVID-19: evidence from the epidemic in Wuhan, China
  1. Yawen Jiang1,
  2. Dan Cai1,
  3. Daqin Chen1,
  4. Shan Jiang2
  1. 1 School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China
  2. 2 School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Yawen Jiang; jiangyw26{at}


Objectives The objectives were to evaluate the effectiveness of conducting three versus two reverse transcription-PCR (RT-PCR) tests for diagnosing and discharging people with COVID-19 with regard to public health and clinical impacts by incorporating asymptomatic and presymptomatic infection and to compare the medical costs associated with the two strategies.

Methods A model that consisted of six compartments was built. The compartments were the susceptible (S), the asymptomatic infective (A), the presymptomatic infective (L), the symptomatic infective (I), the recovered (R), and the deceased (D). The A, L and I classes were infective states. To construct the model, several parameters were set as fixed using existing evidence and the rest of the parameters were estimated by fitting the model to a smoothed curve of the cumulative confirmed cases in Wuhan from 24 January 2020 to 6 March 2020. Input data about the cost-effectiveness analysis were retrieved from the literature.

Results Conducting RT-PCR tests three times for diagnosing and discharging people with COVID-19 reduced the estimated total number of symptomatic cases to 45‌ 013 from 51 144 in the two-test strategy over 43 days. The former strategy also led to 850.1 quality-adjusted life years (QALYs) of health gain and a net healthcare expenditure saving of CN¥49.1 million. About 100.7 QALYs of the health gain were attributable to quality-adjusted life day difference between the strategies during the analytic period and 749.4 QALYs were attributable to years of life saved.

Conclusions More accurate strategies and methods of testing for the control of COVID-19 may reduce both the number of infections and the total medical costs. Increasing the number of tests should be considered in regions with relatively severe epidemics when existing tests have moderate sensitivity.

  • health economics
  • pneumonia
  • PCR
  • mathematical modelling

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  • Handling editor Seye Abimbola

  • Contributors Conceptualisation, design, data collection, analysis and writing: YJ. Data collection and analysis: D Cai. Data collection: D Chen. Analysis and writing: SJ.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on request. The data analysed during the current study are publicly available from the website of China National Health Commission or included in this article. The code and modelling files that support the findings of this study are available from the corresponding author on reasonable request.

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