Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
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 4

One-way sensitivity analyses of the base-case analysis in an economic evaluation of wastewater surveillance combined with clinical COVID-19 screening tests, Japan*

Parameters Parameter values ROI†
 Relative ROI‡
Option 1 Option 2
Test characteristics
Sensitivity
Wastewater surveillance 0.46 0.21 0.12 2
0.84 0.21 0.26 80
PCR 0.64 0.18 0.22 32
0.83 0.23 0.22 4
Ratio of antigen test against PCR test 0.54 0.14 0.22 −5.43
0.97 0.24 0.22 3
PCR test after positive antigen test 0.64 0.12 0.10 5
0.999 0.21 0.22 6
Specificity
PCR 0.96 0.21 0.21 5
0.995 0.21 0.25 9
Antigen test 0.97 0.19 0.22 9
0.995
 0.22
 0.22
 6
Cost
Wastewater surveillance cost per day per facility
Laboratory cost $189 0.21 0.25 9
$758 0.21 0.18 0.96
Labor cost to sample $152 0.21 0.50 20
$2,045 0.21 0.15 −6.43
Antigen test¶ $10 0.33 0.22 −4.91
$23 0.15 0.22 19
Clinical PCR¶ $20 0.215 0.24 7
$53 0.207 0.21 5
Isolation per test-positive case $379 0.209 0.222 6.33
$1,515 0.212 0.224 6.09
Hospitalization per case# $16,212 0.18 0.19 7
$25,227
 0.26
 0.27
 5
Other
Incidence per day per 1 million population 10 0.02 0.02 54
10,000 21 22 0.06
No. residents at a facility 50 0.21 0.12 −14.89
1,000 0.21 0.94 25
Mortality rate among persons who test positive 0.0018 0.19 0.20 7
0.0104 0.30 0.32 4
Ratio of mortality rate among persons >80 years of age vs. 
the general population
 0.5 0.004 0.004 161
22 0.24 0.26 5
Life-years saved by avoiding COVID-19 11.1 0.209 0.221 6.28
11.7 0.211 0.224 6.21
Ratio to convert life-years saved to QALYs saved 0.64 0.207 0.220 6.33
0.71 0.212 0.225 6.19
Hospitalization rate among persons who test positive 0.04 0.08 0.08 14
0.40 0.42 0.46 4
Proportion of severe cases among hospitalized cases 0.05 0.18 0.19 7
0.19 0.26 0.28 5
Effective reproduction number of infected cases 0.9 0.28 0.31 7
2.0 0.17 0.16 5
Effectiveness of screening in reducing hospitalization and mortality 
rates because of an earlier diagnosis
 0.23 0.09 0.10 14
0.62 0.24 0.26 5
Ratio of loss value of missing and infected cases compared with benefit 
value of finding an infected case 0.0 0.25 0.31 148
2.0 0.17 0.13 3

*The lower and upper bounds of each parameter are shown to illustration the association between a parameter and its ROI. Incidence was assumed to be 100 persons per day per 1 million residents in the area. All monetary values are expressed in 2022 US dollars. QALY, quality-adjusted life-years; ROI, return on investment. †Option 1 is clinical tests only; option 2 is wastewater surveillance and clinical tests. ‡Relative ROI of option 2 compared with option 1.

Main Article

Page created: June 02, 2023
Page updated: July 20, 2023
Page reviewed: July 20, 2023
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external