Tags

Type your tag names separated by a space and hit enter

Antigen-based rapid diagnostic testing or alternatives for diagnosis of symptomatic COVID-19: A simulation-based net benefit analysis.
Epidemiology. 2021 Jul 13 [Online ahead of print]E

Abstract

BACKGROUND

SARS-CoV-2 antigen-detection rapid diagnostic tests can diagnose COVID-19 rapidly and at low cost, but lower sensitivity compared with reverse-transcriptase polymerase chain reaction (PCR) has limited clinical adoption.

METHODS

We compared antigen testing, PCR testing, and clinical judgment alone for diagnosing symptomatic COVID-19 in an outpatient setting (10% COVID-19 prevalence among the patients tested, 3-day PCR turnaround) and a hospital setting (40% prevalence, 24-hour PCR turnaround). We simulated transmission from cases and contacts, and relationships between time, viral burden, transmission, and case detection. We compared diagnostic approaches using a measure of net benefit that incorporated both clinical and public health benefits and harms of intervention.

RESULTS

In the outpatient setting, we estimated that using antigen testing instead of PCR to test 200 individuals could be equivalent to preventing all symptomatic transmission from one person with COVID-19 (one "transmission-equivalent"). In a hospital, net benefit analysis favored PCR, and testing 25 patients with PCR instead of antigen testing achieved one transmission-equivalent of benefit. In both settings, antigen testing was preferable to PCR if PCR turnaround time exceeded 2 days. Both tests provided greater net benefit than management based on clinical judgment alone, unless intervention carried minimal harm and was provided equally regardless of diagnostic approach.

CONCLUSIONS

For diagnosis of symptomatic COVID-19, we estimated that speed of diagnosis with antigen testing is likely to outweigh its lower accuracy compared to PCR wherever PCR turnaround time is 2 days or longer. This advantage may be even greater if antigen tests are also less expensive.

Authors+Show Affiliations

Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA MRC Centre for Global Infectious Disease Analysis, Imperial College, London, UK Foundation for Innovative New Diagnostics, Geneva, Switzerland.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

34292212

Citation

Kendall, Emily A., et al. "Antigen-based Rapid Diagnostic Testing or Alternatives for Diagnosis of Symptomatic COVID-19: a Simulation-based Net Benefit Analysis." Epidemiology (Cambridge, Mass.), 2021.
Kendall EA, Arinaminpathy N, Sacks JA, et al. Antigen-based rapid diagnostic testing or alternatives for diagnosis of symptomatic COVID-19: A simulation-based net benefit analysis. Epidemiology. 2021.
Kendall, E. A., Arinaminpathy, N., Sacks, J. A., Manabe, Y. C., Dittrich, S., Schumacher, S. G., & Dowdy, D. W. (2021). Antigen-based rapid diagnostic testing or alternatives for diagnosis of symptomatic COVID-19: A simulation-based net benefit analysis. Epidemiology (Cambridge, Mass.). https://doi.org/10.1097/EDE.0000000000001400
Kendall EA, et al. Antigen-based Rapid Diagnostic Testing or Alternatives for Diagnosis of Symptomatic COVID-19: a Simulation-based Net Benefit Analysis. Epidemiology. 2021 Jul 13; PubMed PMID: 34292212.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antigen-based rapid diagnostic testing or alternatives for diagnosis of symptomatic COVID-19: A simulation-based net benefit analysis. AU - Kendall,Emily A, AU - Arinaminpathy,Nimalan, AU - Sacks,Jilian A, AU - Manabe,Yukari C, AU - Dittrich,Sabine, AU - Schumacher,Samuel G, AU - Dowdy,David W, Y1 - 2021/07/13/ PY - 2021/7/23/pubmed PY - 2021/7/23/medline PY - 2021/7/22/entrez JF - Epidemiology (Cambridge, Mass.) JO - Epidemiology N2 - BACKGROUND: SARS-CoV-2 antigen-detection rapid diagnostic tests can diagnose COVID-19 rapidly and at low cost, but lower sensitivity compared with reverse-transcriptase polymerase chain reaction (PCR) has limited clinical adoption. METHODS: We compared antigen testing, PCR testing, and clinical judgment alone for diagnosing symptomatic COVID-19 in an outpatient setting (10% COVID-19 prevalence among the patients tested, 3-day PCR turnaround) and a hospital setting (40% prevalence, 24-hour PCR turnaround). We simulated transmission from cases and contacts, and relationships between time, viral burden, transmission, and case detection. We compared diagnostic approaches using a measure of net benefit that incorporated both clinical and public health benefits and harms of intervention. RESULTS: In the outpatient setting, we estimated that using antigen testing instead of PCR to test 200 individuals could be equivalent to preventing all symptomatic transmission from one person with COVID-19 (one "transmission-equivalent"). In a hospital, net benefit analysis favored PCR, and testing 25 patients with PCR instead of antigen testing achieved one transmission-equivalent of benefit. In both settings, antigen testing was preferable to PCR if PCR turnaround time exceeded 2 days. Both tests provided greater net benefit than management based on clinical judgment alone, unless intervention carried minimal harm and was provided equally regardless of diagnostic approach. CONCLUSIONS: For diagnosis of symptomatic COVID-19, we estimated that speed of diagnosis with antigen testing is likely to outweigh its lower accuracy compared to PCR wherever PCR turnaround time is 2 days or longer. This advantage may be even greater if antigen tests are also less expensive. SN - 1531-5487 UR - https://www.unboundmedicine.com/medline/citation/34292212/Antigen-based_rapid_diagnostic_testing_or_alternatives_for_diagnosis_of_symptomatic_COVID-19:_A_simulation-based_net_benefit_analysis. L2 - https://doi.org/10.1097/EDE.0000000000001400 DB - PRIME DP - Unbound Medicine ER -
Try the Free App:
Prime PubMed app for iOS iPhone iPad
Prime PubMed app for Android
Prime PubMed is provided
free to individuals by:
Unbound Medicine.