Colleen Weatherwax

Background: Long coronavirus disease (COVID), which affects an estimated 44.69–48.04 million people in the United States, is an ongoing public health concern that will persist as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread. Methods: We developed a computational simulation model representing the clinical course, health effects, and associated costs of a person with long COVID. Results: Simulations show that the average total cost of a long COVID case can range from $5084–$11 646 (assuming symptoms only last 1 year) with 92.5%–95.2% of these costs being productivity losses. Therefore, the current number of long COVID cases could cost society at least $2.01–$6.56 billion, employers at least $1.99–$6.49 billion in productivity losses, and third-party payers $21.0–$68.5 million annually (6%–20% probability of developing long COVID). These cases would accrue 35 808–121 259 quality-adjusted life-years (QALYs) lost and 13 484–45 468 disability-adjusted life-years (DALYs) and would rise as COVID-19 incidence increases. Conclusions: The current health and economic burden of long COVID may already exceed that of a number of other chronic diseases and will continue to grow each year as COVID-19 cases increase. This could be a significant drain on businesses, third-party payers, the healthcare system, and society.

Objective: Nursing home residents may be particularly vulnerable to coronavirus disease 2019 (COVID-19). Therefore, a question is when and how often nursing homes should test staff for COVID-19 and how this may change as severe acute respiratory coronavirus virus 2 (SARS-CoV-2) evolves.Design: We developed an agent-based model representing a typical nursing home, COVID-19 spread, and its health and economic outcomes to determine the clinical and economic value of various screening and isolation strategies and how it may change under various circumstances.Results: Under winter 2023–2024 SARS-CoV-2 omicron variant conditions, symptom-based antigen testing averted 4.5 COVID-19 cases compared to no testing, saving $191 in direct medical costs. Testing implementation costs far outweighed these savings, resulting in net costs of $990 from the Centers for Medicare & Medicaid Services perspective, $1,545 from the third-party payer perspective, and $57,155 from the societal perspective. Testing did not return sufficient positive health effects to make it cost-effective [$50,000 per quality-adjusted life-year (QALY) threshold], but it exceeded this threshold in ≥59% of simulation trials. Testing remained cost-ineffective when routinely testing staff and varying face mask compliance, vaccine efficacy, and booster coverage. However, all antigen testing strategies became cost-effective (≤$31,906 per QALY) or cost saving (saving ≤$18,372) when the severe outcome risk was ≥3 times higher than that of current omicron variants.Conclusions: SARS-CoV-2 testing costs outweighed benefits under winter 2023–2024 conditions; however, testing became cost-effective with increasingly severe clinical outcomes. Cost-effectiveness can change as the epidemic evolves because it depends on clinical severity and other intervention use. Thus, nursing home administrators and policy makers should monitor and evaluate viral virulence and other interventions over time.