Yale study: Sending tests home save lives
$68 per person would cut deaths by 15,700, researchers conclude
“We now have more than one strategy at our disposal to start containing this pandemic.”
A. David Paltiel, Yale professor
NEW HAVEN — In two months, the nation could prevent 2.8 million COVID-19 infections and save 15,700 lives if every household was given a set of test kits to use once a week, according to a study by the Yale School of Public Health.
This would be true even if most people threw the tests away or ignored the results, the research, published Tuesday in Annals of Internal Medicine, found. The cost would be about $68 per person, the study found.
The concept is not new, professor A. David Paltiel said Tuesday.
“Interventions of this kind have been employed in different parts of the world before,” such as in screening for malaria, he said.
Rapid antigen tests, performed regularly, would warn people if they are potentially contagious and should isolate themselves, the researchers said. Paltiel and co-author Paul D. Sax of Brigham and Women’s Hospital and Harvard Medical School looked at data on the epidemiology of the coronavirus and the progression of COVID-19 to estimate the reduction in infections, hospitalizations and deaths, according to a release.
“We collected as much data as we could on the progression of the epidemic through the population as well as the progression of the infection through the individual,” Paltiel said.
The researchers also took the worst-case scenario to be sure they were not overstating the effectiveness of home testing or the costs, he said. Such screening has been done “in resource-limited settings for 20 cents a test,” but the study assumed a cost of $5 per test, he said.
“We deliberately biased the analysis against our findings by leaning heavily on the scale and portraying in a pessimistic and unfavorable light,” Paltiel said.
Home testing has been criticized by those who believe people will not follow through on taking the tests and because there may be frequent false-negative results as well as false positives. The false positives could result in unneeded isolation and lost work productivity, according to the release.
The study assumed that three-fourths of households would throw the kits away, that as many as 75 percent would ignore a positive result and that fewer than 25 percent of people who chose to selfisolate would do so for the recommended seven days.
“We made equally pessimistic assumptions about the costs and accuracy of the tests. And still we found that it would confer an outstanding value,” Sax said in the release.
“We took those objections and we baked them right into our analysis,” Paltiel said. “I think we went to some pretty elaborate lengths to take into account the objections the skeptics have had.”
The $68 cost per person includes $38 for testing, $32 in additional workday productivity losses and savings of $2 in inpatient hospitalization. The resulting cost-effectiveness ratio would be $1.43 million per death averted, they said. Paltiel said that figure was arrived at by multiplying the $68 test cost by the 330 million U.S. population and dividing it by 15,700 deaths saved.
He said $1.43 million per death averted “is a very good bargain,” as studies of how much value to put on human life regularly calculate it as between $5 million and $17 million.
“We now have more than one strategy at our disposal to start containing this pandemic,” Paltiel said.
Even with vaccines rolling out, “Right now the vaccine is a bucket of water compared to the forest fire that is raging through our communities,” he said. Home testing, plus continued wearing of masks, social distancing and other basic health measures are all needed he said.
In order to roll out such a broad-based program, “You’ve got to convince the Food and Drug Administration to authorize this kind of testing for home use without a doctor’s prescription,” Paltiel said. The FDA has not done so, “for reasons I still can’t fathom,” he said.