Cost-effectiveness of anti-SARS-CoV-2 antibody diagnostic tests in Brazil

• Published in: PloS one 2022-02, Vol.17 (2), p.e0264159
• Main Authors: de Assis, Tália Santana Machado, Freire, Mariana Lourenço, Carvalho, Janaína de Pina, Rabello, Ana, Cota, Gláucia
• Format: Article
• Language: English
• Subjects: Accuracy; Analysis; Antibodies; Antibodies, Viral - isolation & purification; Brazil; Coronaviruses; Cost analysis; Cost-Benefit Analysis; COVID-19; COVID-19 - diagnosis; COVID-19 - virology; COVID-19 diagnostic tests; COVID-19 Testing - economics; COVID-19 Testing - methods; Diagnosis; Diagnostic systems; Diagnostic tests; Disease transmission; Economic analysis; Engineering and Technology; Enzyme-linked immunosorbent assay; Evaluation; Humans; Immunoglobulin G; Immunoglobulin M; Infections; Medical diagnosis; Medical tests; Medicine and Health Sciences; Pandemics; People and places; Public health; Research and Analysis Methods; Sensitivity and Specificity; Serology; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Social Sciences; Tropical diseases; Viral antibodies
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0264159

Although serologic tests for COVID-19 diagnosis are rarely indicated nowadays, they remain commercially available and widely used in Brazil. The objective of this study was to evaluate the cost-effectiveness of anti-SARS-CoV-2antibody diagnostic tests for COVID-19 in Brazil. Eleven commercially available diagnostic tests, comprising five lateral-flow immunochromatographic assays (LFAs) and six immunoenzymatic assays (ELISA) were analyzed from the perspective of the Brazilian Unified Health System. The direct costs of LFAs ranged from US$ 11.42 to US$ 17.41and of ELISAs, from US$ 6.59 to US$ 10.31. Considering an estimated disease prevalence between 5% and 10%, the anti-SARS-CoV-2 ELISA (IgG) was the most cost-effective test, followed by the rapid One Step COVID-19 Test, at an incremental cost-effectiveness ratio of US$ 2.52 and US$ 1.26 per properly diagnosed case, respectively. Considering only the LFAs, at the same prevalence estimates, two tests, the COVID-19 IgG/IgM and the One Step COVID-19 Test, showed high effectiveness at similar costs. For situations where the estimated probability of disease is 50%, the LFAs are more costly and less effective alternatives. Nowadays there are few indications for the use of serologic tests in the diagnosis of COVID-19 and numerous commercially available tests, with marked differences are observed among them. In general, LFA tests are more cost-effective for estimated low-COVID-19-prevalences, while ELISAs are more cost-effective for high-pretest-probability scenarios.