Background: Colleges in the United States are determining how to operate safely amid the coronavirus disease 2019 (COVID-19) pandemic Objective: To examine the clinical outcomes, cost, and cost-effectiveness of COVID-19 mitigation strategies on college campuses Design: The Clinical and Economic Analysis of COVID-19 interventions (CEACOV) model, a dynamic microsimulation model, was used to examine alternative mitigation strategies The CEACOV model tracks infections accrued by students and faculty, accounting for community transmissions Data Sources: Data from published literature were used to obtain parameters related to COVID-19 and contact-hours Target Population: Undergraduate students and faculty at U S colleges Time Horizon: One semester (105 days) Perspective: Modified societal Intervention: COVID-19 mitigation strategies, including social distancing, masks, and routine laboratory screening Outcome Measures: Infections among students and faculty per 5000 students and per 1000 faculty, isolation days, tests, costs, cost per infection prevented, and cost per quality-adjusted life-year (QALY) Results of Base-Case Analysis: Among students, mitigation strategies reduced COVID-19 cases from 3746 with no mitigation to 493 with extensive social distancing and masks, and further to 151 when laboratory testing was added among asymptomatic persons every 3 days Among faculty, these values were 164, 28, and 25 cases, respectively Costs ranged from about $0 4 million for minimal social distancing to about $0 9 million to $2 1 million for strategies involving laboratory testing ($10 per test), depending on testing frequency Extensive social distancing with masks cost $170 per infection prevented ($49 200 per QALY) compared with masks alone Adding routine laboratory testing increased cost per infection prevented to between $2010 and $17 210 (cost per QALY gained, $811 400 to $2 804 600) Results of Sensitivity Analysis: Results were most sensitive to test costs Limitation: Data are from multiple sources Conclusion: Extensive social distancing with a mandatory mask-wearing policy can prevent most COVID-19 cases on college campuses and is very cost-effective Routine laboratory testing would prevent 96% of infections and require low-cost tests to be economically attractive Primary Funding Source: National Institutes of Health
College Campuses and COVID-19 Mitigation: Clinical and Economic Value