The cost-effectiveness of common strategies for the prevention of transmission of SARS-CoV-2 in universities.

Background. As universities re-open, it is imperative to understand the added value of measures to prevent the transmission of SARS-CoV-2, the virus that causes COVID-19. Methods. We conducted a cost-effectiveness analysis of common public health interventions used by universities to reduce SARS-CoV-2 transmission. We use a Markov model with Monte Carlo simulations, cycling once per day. The model computes changes in infection among interacting groups of university affiliates both on and off campus. Interventions are compared with the Centers for Disease Control and Prevention (CDC) guidelines at three different levels of actively infectious cases of COVID-19 in the community surrounding the university in terms of incremental cost per incremental quality-adjusted life year (QALY) gained. Results. When there are 100 infectious cases per 100,000 people in the community (0.1%), a symptom-checking mobile application is cost-effective relative to CDC guidelines alone. If the community active infectious case rate reaches 1%, providing high quality, 2-ply masks will be cost-saving. As the community prevalence rate of infectious cases reaches 2%, thermal imaging cameras cost $965,070/QALY gained (95% credible interval [CrI] = $198,821 QALY gained, $2.15 million/QALY gained). One-time PCR testing on entry costs $1.08 million/QALY gained (95% CrI = $170,703 QALY gained, $3.33 million/QALY gained). Weekly PCR testing costs $820,119 /QALY gained (95% CrI = $452,673 QALY gained, $1.68 million/QALY gained). Upgrades to ventilation systems or installation of far-UVC light systems will be cost-effective at a willingness-to-pay threshold of $150,000/QALY gained if aerosols account for 86% of all on-campus transmission of SARS-CoV-2. Conclusions. The value of commonly used interventions for the prevention of SARS-CoV-2 varies greatly with the rate of actively infectious cases of COVID-19 in the community surrounding the university.