Objective: To compare NHS organisations testing pathways for patients with suspected COVID-19 in the community versus standard hospital testing practices

Perspective: NHS commissioners and services

Methods: During the containment phase of the Covid-19 pandemic we developed a community model pathway for Covid-19 testing in Wales with testing teams undertaking swabbing for Covid-19 in individuals usual place of residence. We undertook a cost-minimisation analysis comparing the costs to the NHS in Wales of community testing for COVID-19 versus standard hospital testing practices and ambulance conveyancing. We analysed data from patients with suspected COVID-19 between January and February 2020 and applied assumptions of costs from national contractual and reference costs for ambulances, staffing and transportation with market costs at the time of publication.

Results: 177 patients with suspected COVID-19 underwent community testing via local NHS organisations between January and February 2020 with a mean age of 46.1 (IQR 27.5-56.3). This was 92% of total patients who were tested for Covid-19 during this period. We estimate, compared to standard hospital testing practices cash savings in improved productivity for the NHS of £152,190 during this time period, in addition to further non-monetised benefits for hospital and ambulance flow.

Conclusions: Community testing for COVID-19 in Wales is now an established pathway and continues to bring benefits for patients, local healthcare organisations and the NHS. Further application of this model in other settings and to other infectious diseases may herald promising returns.

Data on numbers of people tested and their demographic and epidemiological information was maintained on a dataset held by the Public Health Wales Microbiology Division. This dataset additionally collated information on time to test, time to result, the result of common respiratory pathogen screen and reference laboratory results. We report here on data collected between 17^th January-17^th February 2020, excluding cases for which there was no sample collected (n=3) or no postcode recorded (n=4). We undertook a cost-minimisation analysis on the assumption that there was no significant difference in outcome of testing people with suspected COVID-19 in the community versus usual hospital care. Due to available data, we focus exclusively on the perspective of the health service provider and on health service costs and used then contemporary market prices.