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Volume 29, Number 8—August 2023
Research

Economic Evaluation of Wastewater Surveillance Combined with Clinical COVID-19 Screening Tests, Japan

Byung-Kwang YooComments to Author , Ryo Iwamoto, Ungil Chung, Tomoko Sasaki, and Masaaki Kitajima
Author affiliations: Waseda University, Saitama, Japan (B.-K. Yoo); Kanagawa University of Human Services, Kanagawa, Japan (B.-K. Yoo, U. Chung); Shionogi & Co. Ltd. and AdvanSentinal Inc., Osaka, Japan (R. Iwamoto); The University of Tokyo, Tokyo, Japan (U. Chung); Independent consultant, Shiga, Japan (T. Sasaki); Hokkaido University, Hokkaido, Japan (M. Kitajima)

Main Article

Table 1

Decision model parameters in an economic evaluation of wastewater surveillance combined with clinical COVID-19 screening tests, Japan*

Parameters† Point estimate (range) Reference
Test characteristics
Sensitivity
Wastewater surveillance 0.66 (0.46–0.84) M. Kitajima, unpub. data
PCR‡ 0.74 (0.64–0.83) (8,9)
Ratio of antigen test against PCR test 0.76 (0.54–0.97) (8–10)
PCR test after positive antigen test 0.99 (0.64–0.999) (8,9)
Specificity
PCR 0.974 (0.96–0.995) (9,10)
Antigen test 0.99 (0.97–0.995) (10)
Ratio of wastewater surveillance against PCR test
 0.99
Cost
Laboratory cost of wastewater surveillance per facility per day $379 ($189–$758) (11,12)
Labor cost to sample at a facility per facility per day $1,136 ($152–$2,045) (13)
Antigen test§ $16 ($10–$23) (14,15)
Clinical PCR§ $38 ($20–$53) (14,15)
Isolation per test-positive case $758 ($379–$1,515) (16)
Hospitalization per case¶ $19,394 ($16,212–$25,227) (17–19)
Value of QALY saved per case
 $37,879
 (20)
Other
Incidence per day per 1 million residents 100 (10–10,000) (4,21)
No. residents at a facility 100 (50–200) (6,22)
Mortality rate among persons who test positive# 0.0035 (0.0018–0.0104) (23)
Ratio of mortality rate among persons >80 years of age vs. general population 19 (15–22) (23)
Life-years saved by avoiding COVID-19 11.4 (11.1–11.7) (24,25)
Ratio to convert life-years saved to QALYs saved 0.68 (0.64–0.71) (24,26)
Hospitalization rate among persons who test positive 0.18 (0.04–0.40) (17)
Proportion of severe cases among hospitalized cases 0.1 (0.05–0.19) (17)
Effective reproduction number of infected cases 1.3 (0.9–2.0) (27)
Screening effectiveness in reducing hospitalization and mortality rates 
because of an earlier diagnosis 0.54 (0.23–0.62) (28)
Ratio of loss value of missing an infected case compared with benefit value 
of finding an infected case 1 (0–2.0)

*All monetary values are expressed in 2022 US dollars. QALY, quality-adjusted life-years. †All parameters with a minimum and a maximum value in this table are defined as a triangular distribution in the probabilistic analysis, detailed in the Appendix (https://wwwnc.cdc.gov/EID/article/29/8/22-1775-App1.pdf). ‡Because the second clinical PCR test was conducted immediately after the first clinical PCR test, the sensitivity of the second clinical PCR was assumed to be equal to the specificity of the PCR test in this table. §Test cost plus labor cost for sampling; 30 min multiplied by minimum wage of $7 USD per hour (15). ¶Hospitalization cost was assumed as $16,212 + $64,394 x (proportion of severe cases among hospitalized cases – 0.05). #The range was defined to range from the rate before the vaccination period to the rate after the vaccination period (Appendix).

Main Article

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Page created: June 02, 2023
Page updated: July 20, 2023
Page reviewed: July 20, 2023
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