The 3rd annual MEED Research Forum took place on Friday, September 24th over Zoom. The organising committee decided that it was high-time for the health economics cabal to start discussing their contribution to the COVID-19 pandemic with respect to diagnostics. So, a programme was assembled of empirical researchers and panellists to shed light on: The role of health economics in a global pandemic – lessons learnt from COVID-19.
Session 1: Economic modelling with application to COVID-19 diagnostics
To kick-off proceedings, Simon Walker from the University of York discussed their published paper in Pharmacoeconomics entitled: Jointly modelling economics and epidemiology to support public policy decisions for the COVID-19 response: a review of UK studies. In their analysis, 11 studies were included in a narrative synthesis. The authors showed that attempts are being made in the UK to balance the health and outcomes of pandemic-related policies using a joint epidemiological and economic modelling framework, but they call for better linkage between impact from epidemiological models and economic costs of different policies for the appropriate assessment of COVID-19 policies. In those earlier studies, only one study (Aum, Lee and Shin, 2021) considered a ‘virus visas’ policy, which implicitly requires antibody tests (a blood test) to be widely available.
Next-up was Janet Bouttell from the University of Glasgow, who discussed her Medical Decision Making paper entitled: Evaluation of triage tests when existing test capacity Is constrained: application to rapid diagnostic testing in COVID-19. This presentation showed that, where the reference test capacity is constrained and triage tests are unconstrained, the assessment of the opportunity cost of a triage strategy depends on the cost of the triage testing and an assessment of the value of the additional cases identified. The number of additional cases identified is maximized by maximizing specificity. The argument is that sensitivity is less important, as false-negatives at triage testing do not directly represent missed cases.
The keynote speaker was Matt Stevenson from the University of Sheffield, who spoke about his experiences of the NIHR HTA funded project entitled: Modelling of hypothetical SARC-CoV-2 point-of-care tests on admission to hospital from A&E: rapid cost-effectiveness analysis. This talk was illuminating in terms of the time pressure (<3 months in the summer of 2020) that Matt and colleagues were under to deliver an extreme form of early economic evaluation for NICE. The focus of the project was on SARS-CoV-2 viral detection point of care tests (POCTs), which aimed to provide accurate diagnosis on hospital admission in a much quicker time than standard lab-based tests. The modelling was undertaken in Simul8 (not a standard NICE software package) due to the complexity of the modelling. The results were indicative rather than definitive but showed that using POCT for SARS-CoV-2 at the point of admission to hospital may reduce the number of infections compared to using lab-based testing and considerably improve patient flow. An interesting analysis highlighted that the cost-effectiveness of introducing weekly testing of asymptomatic staff is uncertain but may cost between £20,000 and £40,000 per QALY gained. These POCTs have not come to fruition but the model is ready if needed in the future.
Session 2: Has the contribution of health economics to the COVID-19 diagnostics landscape been successful?
The three speakers were joined by Joy Allen (Newcastle University) and Ian Hall (University of Manchester) who eloquently spoke about their personal contributions to UK policy. Joy spoke about the role of health economics via the CONDOR platform (that’s the COVID-19 National DiagnOstic Research and Evaluation platform). Ian spoke candidly about his experiences as a modeller seconded to Public Health England. The discussion, with comments from the 120+ attendees, highlighted that now, a bit later in the pandemic, the role of health economics is needed to help guide decisions on the use of diagnostics. It is hoped that MEED 2022 will be an in-person event and that some more of the health economics contribution to the world of COVID-19 diagnostics will be discussed.