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Grand Rounds

Saliva vs Nasopharyngeal Swabs for COVID-19 Testing: Do the Costs and Sensitivities Differ?

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BACKGROUND AND PURPOSE:

  • Bastos et al. (Annals of Internal Medicine, 2021) assessed
    • The difference in sensitivity for SARS-CoV-2 detection between nasopharyngeal swabs and saliva
    • The incremental cost per additional infection detected with nasopharyngeal swabs

METHODS:

  • Systematic review and meta-analysis
  • Inclusion criteria
    • Studies that included at least 5 paired nasopharyngeal swab and saliva samples
    • Studies that reported diagnostic accuracy for SARS-CoV-2 detection
  • Study design
    • Cost inputs were from nationally representative sources in Canada and were converted to 2020 U.S. dollars
  • Price per test assumptions
    • Cost of materials and personnel to collect the samples
    • Nasopharyngeal swab collection would take longer, use higher level healthcare personnel, and require more extensive PPE

RESULTS:

  • 37 studies | 7332 paired samples
  • Overall
    • Sensitivity of saliva was 3.4 percentage points lower vs nasopharyngeal swabs (95% CI, 9.9 percentage points lower to 3.1 percentage points higher)
    • Pooled saliva sensitivity: 86.9% (95% CI, 82.3% to 90.4%)
  • Among people with previously confirmed SARS-CoV-2 infection
    • Sensitivity of saliva was 1.5 percentage points more sensitive vs nasopharyngeal swabs (95% CI, 7.3 percentage points less to 10.3 percentage points more)
  • Among people without a previous diagnosis
    • Sensitivity of saliva was 7.9 percentage points lower vs nasopharyngeal swabs (95% CI, 14.7 percentage points less to 0.8 percentage point more)
  • Therefore, if one would test 100,000 people without a previous diagnosis in as setting where SARS-CoV-2 had a prevalence of 1%
    • Nasopharyngeal swabs would detect 79 more positive cases than saliva but with an incremental cost of $8093 per case detected with nasopharyngeal swabs

CONCLUSION:

  • COVID-19 PCR tests using saliva appear to have similar sensitivity compared to nasopharyngeal swabs and are also much less expensive

Learn More – Primary Sources:

The Sensitivity and Costs of Testing for SARS-CoV-2 Infection With Saliva Versus Nasopharyngeal Swabs : A Systematic Review and Meta-analysis

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Related ObG Topics:

What is the Data Behind the Use of Saliva Samples for COVID-19 Testing?
COVID-19 Testing: CDC Guidance on Virus and Antibody Testing
What is the Probability of a False Negative When Taking a SARS-CoV-2 Test?

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