Clinical Management Strategies in Mild COVID-19 cases in Latin-America: A Decision Model

• Autor(a) principal: Boissonnet, Carlos P.
• Data de Publicação: 2020
• Outros Autores: Giorgi, Mariano A., Carosella, Lucila, Brescacín, Carola, Pissinis, Jerónimo, Guetta, Javier N.
• Tipo de documento: preprint
• Idioma: spa
• Título da fonte: SciELO Preprints
• Texto Completo: https://preprints.scielo.org/index.php/scielo/preprint/view/681
• topic: Infecciones por coronavirus; Modelos teóricos; Asignación de recursos; Coronavirus infections; Theoretical models; Resource allocation

COVID-19 pandemic is challenging Latin American health systems, which could benefit from information to make appropriate decisions in contexts of constrained health resources.Objective: to evaluate, in adult patients with suspected mild clinical forms of COVID-19, the clinical effectiveness (life expectancy) and resource consumption (days of hospitalization) of different management strategies.Methods: stochastic decision tree comparing the conventional strategy recommended by WHO - PAHO (diagnostic test for COVID-19 and hospitalization of patients testing positive) versus two alternative strategies (immediate addition of a prognostic test with hospitalization according to its result, or follow-up with hospitalization only in case of clinical deterioration).Results: the alternative management strategies showed expected clinical utility similar to the conventional strategy in 80 years-old base cases, and slightly lower in 60 years- and 40 years-old base cases, with lower consumption of hospitalization days. In sensitivity analysis, alternative strategies comparatively improved their expected clinical utility given a lower sensitivity of the diagnostic test or a higher ability of the follow-up to detect clinical worsening.Conclusions: in cases of suspected COVID-19 without pneumonic infiltrate or signs of severity, alternative strategies can be considered to avoid hospitalization for the majority of patients, especially if efficient follow-up modalities can be implemented. This information is valuable for health decision-makers, to carefully weight clinical and epidemiological elements and design locally feasible strategies.