Elsevier

Gastrointestinal Endoscopy

Volume 92, Issue 3, September 2020, Pages 524-534.e6
Gastrointestinal Endoscopy

Original article
Clinical endoscopy
COVID-19 polymerase chain reaction testing before endoscopy: an economic analysis

https://doi.org/10.1016/j.gie.2020.04.049Get rights and content

Background and Aims

The novel coronavirus disease 2019 (COVID-19) pandemic has limited endoscopy utilization, causing significant health and economic losses. We aim to model the impact of polymerase chain reaction (PCR) testing into resuming endoscopy practice.

Methods

We performed a retrospective review of endoscopy utilization during the COVID-19 pandemic for a baseline reference. A computer model compared 3 approaches: strategy 1, endoscopy for urgent indications only; strategy 2, testing for semiurgent indications; and strategy 3, testing all patients. Analysis was made under current COVID-19 prevalence and projected prevalence of 5% and 10%. Primary outcomes were number of procedures performed and/or canceled. Secondary outcomes were direct costs, reimbursement, personal protective equipment used, and personnel infected. Disease prevalence, testing accuracy, and costs were obtained from the literature.

Results

During the COVID-19 pandemic, endoscopy volume was 12.7% of expected. Strategies 2 and 3 were safe and effective interventions to resume endoscopy in semiurgent and elective cases. Investing 22 U.S. dollars (USD) and 105 USD in testing per patient allowed the completion of 19.4% and 95.3% of baseline endoscopies, respectively. False-negative results were seen after testing 4700 patients (or 3 months of applying strategy 2 in our practice). Implementing PCR testing over 1 week in the United States would require 13 and 64 million USD, with a return of 165 and 767 million USD to providers, leaving 65 and 325 healthcare workers infected.

Conclusions

PCR testing is an effective strategy to restart endoscopic practice in the United States. PCR screening should be implemented during the second phase of the pandemic, once the healthcare system is able to test and isolate all suspected COVID-19 cases.

Abbreviations

cIFR
corrected infection fatality rate
COVID-19
novel coronavirus disease 2019
PPE
personal protective equipment
PCR
polymerase chain reaction
SARS-CoV-2
severe acute respiratory syndrome–coronavirus 2
USD
U.S. dollars

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DISCLOSURE: The following authors disclosed financial relationships: J. E. Corral: Travel, food, and beverage compensation from Abbvie, Intercept Pharmaceuticals, Janssen Scientific, Boston Scientific, and Cook Medical. M. B. Wallace: Consultant for Virgo Inc, Cosmo/Aries Pharmaceuticals, Anx Robotica, Covidien, GI Supply, Endokey, Endostart, Boston Scientific, and Microtek; research grant recipient from Fujifilm, Boston Scientific, Olympus, Medtronic, Ninepoint Medical, and Cosmo/Aries Pharmaceuticals; stockholder in Virgo Inc; food and beverage compensation from Synergy Pharmaceuticals, Boston Scientific, and Cook Medical. All other authors disclosed no financial relationships.

If you would like to chat with an author of this article, you may contact Dr Wallace at [email protected].

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