Economic Evaluation of Wastewater Surveillance Combined with Clinical COVID-19 Screening Tests, Japan

The COVID-19 pandemic has imposed substantial bur-dens on the global society. To find an optimal combina-tion of wastewater surveillance and clinical testing for tracking COVID-19, we evaluated the economic efficien-cy of hypothetical screening options at a single facility in Japan. To conduct cost-benefit analyses, we developed standard decision models in which we assumed model parameters from literature and primary data, such as screening policies used at the Tokyo Olympic and Para-lympic Village in 2021. We compared hypothetical 2-step screening options that used clinical PCR to diagnose COVID-19 after a positive result from primary screening using antigen tests (option 1) or wastewater surveillance (option 2). Our simulation results indicated that option 2 likely would be economically more justifiable than op-tion 1, particularly at lower incidence levels. Our findings could help justify and promote the use of wastewater surveillance as a primary screening at a facility level for COVID-19 and other infectious diseases.