AHIP study finds COVID-19 diagnostic testing costs could reach 44 billion a year
AHIP retained Wakely Consulting Group to explore the potential costs of COVID-19 testing, including both diagnostic (molecular or antigen) and antibody testing considering different frequencies and costs of testing. The study found that diagnostic testing would cost between $6 billion and $25 billion a year, and antibody testing would cost between $5 billion and $19 billion a year.
These estimates include both the cost of the tests, as well as affiliated healthcare services (e.g., provider visit, urgent care visit) for administering the tests.
Wakely developed a range of potential costs associated with outpatient (diagnostic and antibody) testing that may fall under the three common purposes of tests:
• Medical necessary tests, to diagnose or treat COVID-19.
• Public health tests, to collect and analyze the prevalence of COVID-19 in the population on an ongoing basis.
• Occupational health tests, to ensure workplaces are safe and to significantly reduce the risks of exposure to COVID-19.
The analysis does not distinguish between testing that is medically necessary for patient treatment and testing designed for public health or occupational health purposes. As noted in the report, there is still a great deal of uncertainty on how testing strategies will be developed and deployed – including what tests will be used, and how many tests a person might receive per year on average. Given this uncertainty, the total cost of testing will be less than the combination of the costs of diagnostic and antibody tests. There is also great uncertainty on what these tests will cost, as well as the cost to administer them, resulting in a wide range of estimates.
This report is a supplement to a separate analysis that Wakely conducted on estimated COVID-19 treatment costs for 2020 and 2021. That study found that costs to treat COVID-19 for 2020 and 2021 could reach over $200 billion, excluding testing costs and accounting for deferred or delayed care.
Testing strategies need to be part of a holistic public and occupational health strategy. Federal guidance should consider funding for testing in that context, and should clearly articulate the roles of insurance providers, employers and public health officials. Health insurance providers stand ready to work with employers, public health leaders and policymakers to develop and execute robust strategies to reduce the risks of spreading of the virus.
US must prepare for COVID-19-related drug shortages
A paper published in the Annals of the American Thoracic Society examines the nation’s current shortage of vitally needed medications, and how this dangerous situation is being made worse by the COVID-19 pandemic. The authors provide recommendations on how clinicians and institutions might address potential scarcities of essential medications during the current public health crisis.
In “Preparing for COVID-19 Related Drug Shortages,” Andrew G. Shuman, MD, and co-authors discuss how the federal and state governments, as well as healthcare providers, need to develop ethically sound policies that address already perilously low supplies of certain commonly-used medications, which are dwindling further due to resources needed to combat COVID-19.
“It is critical that these conversations occur now due to current shortages, as well as the necessary lead time to plan for future shortages,” said Dr. Shuman, co-chief of the Clinical Ethics Service, Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School. “Drug shortages have been a national emergency for years and are currently exacerbated due to COVID-19. Issues related to supply chain and anticipated increased ICU needs over the course of the pandemic are worsening the problem.”
Yoram Unguru, MD, MS, MA, a physician-ethicist at The Herman and Walter Samuelson Children’s Hospital at Sinai and Johns Hopkins Berman Institute of Bioethics, who is a co-author of the paper, added, “As of today the American Society of Health-system Pharmacists (ASHP) reports 213 drugs shortages in the United States. It is not just patients with COVID-19 who are affected. One example of a current drug with a critically short supply is Erwinia asparaginase, a life-saving chemotherapeutic agent for both children and adults with cancer.”
Among medical specialties severely affected are oncology, critical care and infectious disease. The authors stated that regional communication among hospitals is an important first step — helping determine how local drug supply chains are affected — and that coordination and sharing mechanisms are also critical. This information sharing would ideally occur via a central repository or clearinghouse. Both the FDA and ASHP also maintain databases of current drug shortages, and independent healthcare companies maintain their own databases that can provide invaluable information. There are a number of barriers to this taking place, among others, the need for cooperation among competing health systems, concerns about potential liability, and legal regulations that affect the transfer of drugs.
Erin Fox, PharmD, a co-author who is director of drug information and support services for Utah Health, noted, “Tantamount to this effort is facilitating communication between pharmacists — those tasked with maintaining supplies, as well as those embedded within clinical teams — in order to inform the clinical team how supply may impact care delivery.”
She continued, “Pandemic-era strategies for conservation of commonly used critical care agents at risk of shortages should be noted, recognizing that these shortages are often regional and unpredictable, and intensive care protocols and strategies are highly individualized.” A list of these commonly used drugs is included in the paper.
The authors noted that communication should not be limited to discussions among pharmacists, hospitals and health systems. Open discussions with patients who are most affected by drug shortages are essential. In the spirit of openness, the authors recommended that hospitals consider publicly posting information about drug shortages.
Dr. Shuman and colleagues called upon stakeholders, from governments to clinicians, to refocus some of their efforts in managing shortages of ventilators during the COVID-19 crisis to develop workflows and rationing criteria for essential medicines. The authors have also identified hoarding of drugs thought to be potential COVID-19 treatments as a problem.
“Once effective treatments and/or vaccines for COVID-19 are available, prioritizing nascent supplies will present a formidable challenge,” they predicted. “In the coming days and months, this matter demands global attention. Only with clear lines of communication and a proactive, collaborative approach can we weather this impending storm.”
Survey shows 39% of respond-ents unsafely using cleaning and disinfectant practices
An internet panel survey identified gaps in knowledge about safe preparation, use and storage of cleaners and disinfectants. Thirty-nine percent of respondents reported engaging in non-recommended high-risk practices with the intent of preventing SARS-CoV-2 transmission, such as washing food products with bleach, applying household cleaning or disinfectant products to bare skin and intentionally inhaling or ingesting these products. A recent report described a sharp increase in calls to poison centers related to exposures to cleaners and disinfectants since the onset of the COVID-19 pandemic. However, data describing cleaning and disinfection practices within household settings in the U.S. are limited, particularly concerning those practices intended to prevent transmission of SARS-CoV-2.
Thirty-nine percent reported intentionally engaging in at least one high-risk practice not recommended by the CDC for prevention of SARS-CoV-2 transmission, including application of bleach to food items (e.g., fruits and vegetables) (19%); use of household cleaning and disinfectant products on hands or skin (18%); misting the body with a cleaning or disinfectant spray (10%); inhalation of vapors from household cleaners or disinfectants (6%); and drinking or gargling diluted bleach solutions, soapy water, and other cleaning and disinfectant solutions (4% each).
This survey identified important knowledge gaps in the safe use of cleaners and disinfectants among U.S. adults; the largest gaps were found in knowledge about safe preparation of cleaning and disinfectant solutions and about storage of hand sanitizers out of the reach of children.
Mixing of bleach solutions with vinegar or ammonia, as well as application of heat, can generate chlorine and chloramine gases that might result in severe lung tissue damage when inhaled. Furthermore, exposures of children to hand sanitizers, particularly via ingestion, can be associated with irritation of mucous membranes, gastrointestinal effects, and in severe cases, alcohol toxicity. The risk of ingestion and consequent toxicity from improperly stored hand sanitizers, cleaners and disinfectants can also extend to pets.
Consistent with current guidance for daily cleaning and disinfection of frequently touched surfaces, a majority of respondents reported increased frequency of cleaning in the home. However, approximately 33% reported engaging in high-risk practices such as washing food products with bleach, applying household cleaning and disinfectant products to bare skin and intentionally inhaling or ingesting cleaners or disinfectants. These practices pose a risk of severe tissue damage and corrosive injury and should be strictly avoided.
Although adverse health effects reported by respondents could not be attributed to their engaging in high-risk practices, the association between these high-risk practices and reported adverse health effects indicates a need for public messaging regarding safe and effective cleaning and disinfection practices aimed at preventing SARS-CoV-2 transmission in households.
