{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T20:36:20Z","timestamp":1772138180251,"version":"3.50.1"},"reference-count":49,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2020,9,18]],"date-time":"2020-09-18T00:00:00Z","timestamp":1600387200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"National Institute for Child Health and Human Development","award":["K08 HD094638"],"award-info":[{"award-number":["K08 HD094638"]}]},{"name":"National Institute for Child Health and Human Development","award":["T32 AI007433"],"award-info":[{"award-number":["T32 AI007433"]}]},{"name":"National Institute for Child Health and Human Development","award":["R37AI058736-16S1"],"award-info":[{"award-number":["R37AI058736-16S1"]}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["210479\/Z\/18\/Z"],"award-info":[{"award-number":["210479\/Z\/18\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,11,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2013consistent symptoms, with self-isolation if positive; (3) symptomatic\u2005+\u2005asymptomatic once: symptomatic and 1-time PCR for the entire population; and (4) symptomatic\u2005+\u2005asymptomatic monthly: symptomatic with monthly retesting for the entire population. We examined effective reproduction numbers (Re = 0.9\u20132.0) 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]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At Re = 0.9, symptomatic\u2005+\u2005asymptomatic monthly vs hospitalized resulted in a 64% reduction in infections and a 46% reduction in deaths, but required &amp;gt;66-fold more tests\/day with 5-fold higher costs. Symptomatic\u2005+\u2005asymptomatic monthly had an ICER &amp;lt;$100\u2005000\/QALY only when Re \u22651.6; when test cost was \u2264$3, every 14-day testing was cost-effective at all Re examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Testing people with any COVID-19\u2013consistent 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciaa1418","type":"journal-article","created":{"date-parts":[[2020,9,17]],"date-time":"2020-09-17T09:10:06Z","timestamp":1600333806000},"page":"e2908-e2917","source":"Crossref","is-referenced-by-count":47,"title":["Clinical Impact, Costs, and Cost-effectiveness of Expanded Severe Acute Respiratory Syndrome Coronavirus 2 Testing in Massachusetts"],"prefix":"10.1093","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7915-4974","authenticated-orcid":false,"given":"Anne M","family":"Neilan","sequence":"first","affiliation":[{"name":"Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA"},{"name":"Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA"},{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA"},{"name":"Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Losina","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"},{"name":"Policy and Innovation eValuation in Orthopedic Treatments Center, Department of Orthopedic Surgery, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"},{"name":"Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Audrey C","family":"Bangs","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clare","family":"Flanagan","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Panella","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G Ege","family":"Eskibozkurt","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amir","family":"Mohareb","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA"},{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA"},{"name":"Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily P","family":"Hyle","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA"},{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA"},{"name":"Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Harvard University Center for AIDS Research, Cambridge, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justine A","family":"Scott","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milton C","family":"Weinstein","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Harvard T. 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Chan School of Public Health , Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark J","family":"Siedner","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA"},{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA"},{"name":"Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Africa Health Research Institute, KwaZulu-Natal, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krishna P","family":"Reddy","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA"},{"name":"Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guy","family":"Harling","sequence":"additional","affiliation":[{"name":"Africa Health Research Institute, KwaZulu-Natal, South Africa"},{"name":"Department of Epidemiology, Harvard T. 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