Risk-based Decision Making Related to Pre-Procedural-COVID-19 Testing in the Setting of Gastrointestinal Endoscopy: Management of Risks, Evidence, and Behavioral Health Economics

Background and Aims Controversies exist in relation to the benefits and the most appropriate approach for pre-procedural COVID-19 testing (e.g., Rapid Antigen Test (RAT) or Polymerase Chain Reaction (PCR) or real time Polymerase Chain Reaction (RT-PCR)) for outpatients undergoing diagnostic and therapeutic procedures, such as gastrointestinal endoscopy, to prevent COVID-19 infections among staff. Guidelines for protecting health care workers (HCW) from SARS-CoV-2 infection via outpatient procedures varies across medical professional organizations. This study provides an evidence-based decision support tool for key decision-makers (e.g., clinicians) to respond to COVID-19 transmission risks and reduce the effect of personal biases. Methods A scoping review was used to identify relevant factors influencing COVID-19 transmission risk relevant for gastrointestinal endoscopy. From 12 relevant publications, eight factors were applicable: test sensitivity, prevalence of SARS-CoV-2 in the population, age adjusted SARS-CoV-2 prevalence in the patient cohort, proportion of asymptomatic patients, risk of transmission from asymptomatic carriers, risk reduction by Personal Protective Equipment (PPE), vaccination rates of HCW. The probability of a serious adverse event (SAE), such as workplace acquired infection resulting in HCW death, under various scenarios with pre-procedural testing is determined and informs decision makers of expected costs of reductions in SAEs. Results In a setting of high community transmission, without testing and PPE, 117·5 SAE per million procedures would occur and this is reduced to between 0·079 to 2·35 SAE per million procedures with use of PPE and pre-procedural testing. Utilising these variables and testing a range of scenarios the probability of an SAE is low even without testing but is reduced by pre-procedural testing. Conclusions Under all scenarios tested, pre-procedural testing reduces the SAE risk