{"doi":"10.1093/cid/ciaa1418","title":"Clinical Impact, Costs, and Cost-effectiveness of Expanded Severe Acute Respiratory Syndrome Coronavirus 2 Testing in Massachusetts","abstract":"BACKGROUND: We projected the clinical and economic impact of alternative testing strategies on coronavirus disease 2019 (COVID-19) incidence and mortality in Massachusetts using a microsimulation model. METHODS: We compared 4 testing strategies: (1) hospitalized: polymerase chain reaction (PCR) testing only for patients with severe/critical symptoms warranting hospitalization; (2) symptomatic: PCR for any COVID-19-consistent symptoms, with self-isolation if positive; (3) symptomatic + asymptomatic once: symptomatic and 1-time PCR for the entire population; and (4) symptomatic + asymptomatic monthly: symptomatic with monthly retesting for the entire population. We examined effective reproduction numbers (Re = 0.9-2.0) at which policy conclusions would change. We assumed homogeneous mixing among the Massachusetts population (excluding those residing in long-term care facilities). We used published data on disease progression and mortality, transmission, PCR sensitivity/specificity (70%/100%), and costs. Model-projected outcomes included infections, deaths, tests performed, hospital-days, and costs over 180 days, as well as incremental cost-effectiveness ratios (ICERs, $/quality-adjusted life-year [QALY]). RESULTS: At Re = 0.9, symptomatic + asymptomatic monthly vs hospitalized resulted in a 64% reduction in infections and a 46% reduction in deaths, but required >66-fold more tests/day with 5-fold higher costs. Symptomatic + asymptomatic monthly had an ICER <$100 000/QALY only when Re ≥1.6; when test cost was ≤$3, every 14-day testing was cost-effective at all Re examined. CONCLUSIONS: Testing people with any COVID-19-consistent symptoms would be cost-saving compared to testing only those whose symptoms warrant hospital care. Expanding PCR testing to asymptomatic people would decrease infections, deaths, and hospitalizations. Despite modest sensitivity, low-cost, repeat screening of the entire population could be cost-effective in all epidemic settings.","journal":"Clinical Infectious Diseases","year":2020,"id":53591,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":115,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9366,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":273594,"name":"Elena Losina","orcid":"0000-0002-3424-0892","position":1,"is_corresponding":false},{"id":273905,"name":"Audrey C. Bangs","orcid":"0000-0002-7283-7200","position":2,"is_corresponding":false},{"id":273589,"name":"Clare Flanagan","orcid":"0000-0002-2425-7690","position":3,"is_corresponding":false},{"id":273587,"name":"Christopher Panella","orcid":"0000-0002-6256-507X","position":4,"is_corresponding":false},{"id":273906,"name":"G. Ege Eskibozkurt","orcid":"0000-0001-6869-9338","position":5,"is_corresponding":false},{"id":234611,"name":"Amir M. Mohareb","orcid":null,"position":6,"is_corresponding":false},{"id":273590,"name":"Emily P. Hyle","orcid":"0000-0001-8721-106X","position":7,"is_corresponding":false},{"id":276136,"name":"Justine A. Scott","orcid":null,"position":8,"is_corresponding":false},{"id":276220,"name":"Milton C. Weinstein","orcid":null,"position":9,"is_corresponding":false},{"id":69650,"name":"Mark J. Siedner","orcid":"0000-0003-3506-842X","position":10,"is_corresponding":false},{"id":273585,"name":"Krishna P. Reddy","orcid":"0000-0002-1832-2193","position":11,"is_corresponding":false},{"id":250367,"name":"Guy Harling","orcid":"0000-0001-6604-491X","position":12,"is_corresponding":false},{"id":273595,"name":"Kenneth A. Freedberg","orcid":"0000-0001-6471-7930","position":13,"is_corresponding":false},{"id":273586,"name":"Fatma M. Shebl","orcid":"0000-0002-9750-0049","position":14,"is_corresponding":false},{"id":273596,"name":"Pooyan Kazemian","orcid":"0000-0002-2846-3862","position":15,"is_corresponding":false},{"id":273593,"name":"Andrea Ciaranello","orcid":"0000-0002-4268-3263","position":16,"is_corresponding":false},{"id":273591,"name":"Anne M. Neilan","orcid":"0000-0001-7915-4974","position":0,"is_corresponding":true}],"reference_count":31,"raw_metadata":null,"created_at":"2026-07-18T20:45:25.145885Z","pmid":"32945845","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}