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COVID-19 Testing Strategies for K-12 Schools in California: A Cost-Effectiveness Analysis

Author

Listed:
  • Sigal Maya

    (Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., Floor 7, San Francisco, CA 94158, USA)

  • Ryan McCorvie

    (California Department of Public Health, Fresno, CA 95899, USA)

  • Kathleen Jacobson

    (California Department of Public Health, Fresno, CA 95899, USA)

  • Priya B. Shete

    (Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA)

  • Naomi Bardach

    (Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., Floor 7, San Francisco, CA 94158, USA
    Safe Schools for All, California Health and Human Services, Sacramento, CA 95814, USA)

  • James G. Kahn

    (Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., Floor 7, San Francisco, CA 94158, USA)

Abstract

Public health officials must provide guidance on operating schools safely during the COVID-19 pandemic. Using data from April–December 2021, we conducted a cost-effectiveness analysis to assess six screening strategies for schools using SARS-CoV-2 antigen and PCR tests and varying screening frequencies for 1000 individuals. We estimated secondary infections averted, quality-adjusted life years (QALYs), cost per QALY gained, and unnecessary school days missed per infection averted. We conducted sensitivity analyses for the more transmissible Omicron variant. Weekly antigen testing with PCR follow-up for positives was the most cost-effective option given moderate transmission, adding 0.035 QALYs at a cost of USD 320,000 per QALY gained in the base case (R eff = 1.1, prevalence = 0.2%). This strategy had the fewest needlessly missed school days (ten) per secondary infection averted. During widespread community transmission with Omicron (R eff = 1.5, prevalence = 5.8%), twice weekly antigen testing with PCR follow-up led to 2.02 QALYs gained compared to no test and cost the least (USD 187,300), with 0.5 needlessly missed schooldays per infection averted. In periods of moderate community transmission, weekly antigen testing with PCR follow up can help reduce transmission in schools with minimal unnecessary days of school missed. During widespread community transmission, twice weekly antigen screening with PCR confirmation is the most cost-effective and efficient strategy. Schools may benefit from resources to implement routine asymptomatic testing during surges; benefits decline as community transmission declines.

Suggested Citation

  • Sigal Maya & Ryan McCorvie & Kathleen Jacobson & Priya B. Shete & Naomi Bardach & James G. Kahn, 2022. "COVID-19 Testing Strategies for K-12 Schools in California: A Cost-Effectiveness Analysis," IJERPH, MDPI, vol. 19(15), pages 1-13, July.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:15:p:9371-:d:876680
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    References listed on IDEAS

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    1. Meng, Xin & Gregory, R G, 2002. "The Impact of Interrupted Education on Subsequent Educational Attainment: A Cost of the Chinese Cultural Revolution," Economic Development and Cultural Change, University of Chicago Press, vol. 50(4), pages 935-959, July.
    2. Meng, Xin & Gregory, Bob, 2007. "Exploring the Impact of Interrupted Education on Earnings: The Educational Cost of the Chinese Cultural Revolution," IZA Discussion Papers 2548, Institute of Labor Economics (IZA).
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    Cited by:

    1. Holly Blake & Sarah Somerset & Ikra Mahmood & Neelam Mahmood & Jessica Corner & Jonathan K. Ball & Chris Denning, 2022. "A Qualitative Evaluation of the Barriers and Enablers for Implementation of an Asymptomatic SARS-CoV-2 Testing Service at the University of Nottingham: A Multi-Site Higher Education Setting in England," IJERPH, MDPI, vol. 19(20), pages 1-17, October.

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