Should COVID-19 rapid antigen tests be government funded?

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The COVID-19 pandemic has directly impacted many areas of healthcare, including service provision and sustainability, the development of new vaccines and testing, and the release of new government policies and funding. One of the main government-funded ventures related to COVID-19 in Australia was the full funding of polymerase chain reaction (PCR) tests, which allowed for free, accurate, and generally accessible testing for Australians. In November 2021, the Australian Therapeutic Goods Association (TGA) also approved the use of rapid antigen tests (RATs), but unlike PCR tests, these were not widely government-funded.

PCHSS lead investigator (Research Stream 3.2) Professor Jonathan Karnon and colleagues have published an economic evaluation of government-funded COVID-19 testing in Australia, which uses quality adjusted life years (QALY) to estimate the economic benefits of different potential funding schemes (e.g., both PCR and RATs funded, no PCR funding but RATs funded etc.). Using an online survey of the Australian population taken in April 2022, the authors also utilised a decision tree structure which sorted branches based on close contact status, use of PCRs and RATs, and whether this meant Early, Late or No Isolation. This was then used to estimate R numbers, which represents an index of the number of people one COVID-19 infected person will infect.

The benefits of PCR testing were to be expected, with government-funded PCR testing avoiding a predicted 12,000 COVID-19 cases per week. But the real question is, should RATs be government-funded? Based on wait times of less than two hours for government-funded PCR tests, funding RATs simultaneously would increase government spending by around $50 million AUD per week. However, this spending may be justified given that the authors found that funding RATs for everyone would reduce the R number, meaning that introducing funding for RATs could reduce the number of infections with the Australian community.

It seems that government funding of RATs for all Australians would be a worthwhile investment, especially considering the continual increase of COVID-19 cases and new variants within the community. But should both RATs and PCR tests be government-funded?

There is no doubt that government-funding of PCR tests has contributed greatly to the reduction of infections within Australia, however, given the high rates of COVID-19 vaccine uptake as well as the limited public health measures in place at the time of writing (July 2022), continued funding may not be necessary. While the monetary benefits of COVID-19 testing maximised when both forms of testing were funded, models where RATs were completely funded and PCR tests were not also had a similar benefit. Even more strikingly, reducing funding for PCR testing and funding RATs for all generated a higher benefits-to-costs ratio compared to other models.

Therefore, based on this economic evidence presented by Professor Karnon and colleagues, the Australian government could reconsider the current funding model of COVID-19 testing, particular in terms of increasing RAT funding and decreasing PCR funding. As we continue to adapt to life in the COVID-19 pandemic, it is decision-making on this level that can make a real difference both for healthcare sustainability and economic outcomes, and it is critical that governments continue to be adaptive and responsive to the new evidence like this that comes to light.

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