# Cost-effectiveness analysis of a text message system for COVID-19 testing for K-12 school communities

## TL;DR

This study evaluates the cost-effectiveness of text message systems to promote equitable COVID-19 testing in K-12 schools.

## Contribution

The study introduces a novel cost-effectiveness analysis of text messaging and health navigation interventions for school-based testing.

## Key findings

- ITM + HN avoided the most missed school days and increased test uptake significantly.
- Adding health navigation to bidirectional text messaging was costlier but more effective.
- ITM alone did not improve outcomes compared to unidirectional messaging.

## Abstract

During the COVID-19 pandemic, school closures led to loss of school-based resources and substantial learning losses for children. To facilitate the return to in-person learning, schools across the US partnered with health agencies to implement strategies such as on-site and at-home COVID-19 testing programs. We aimed to quantify the cost-effectiveness of SCALE-UP Counts, a project that used text messaging and health navigation interventions to promote equitable COVID-19 testing among K-12 school students and their families.

Families of children from sixteen K-12 schools in Utah were randomly assigned to one of three intervention arms from 2022-2023: unidirectional text messages regarding availability of free COVID-19 test kits [UC], intensive bidirectional text messaging with testing guidance and ability to request test kits [ITM], and intensive bidirectional text messaging plus health navigation [ITM + HN]. Expected cost and effectiveness of each approach was measured. Effectiveness was measured as missed school days avoided, missed workdays avoided, and COVID-19 tests taken, and calculated as ratios of differences over differences in costs. The analysis was performed using a decision analytic simulation model with probabilistic sensitivity analysis.

ITM + HN yielded most missed school days avoided (8290 vs. 1840) and COVID-19 tests taken (9468 vs. 1876) but was costlier than UC ($34 vs. $11 per family). The costs for ITM + HN compared to UC were $30/COVID-19 test taken, and $21/missed workday avoided. ITM alone did not yield improved outcomes relative to UC or ITM + HN.

Inclusion of a health navigator substantially enhances the benefits of bidirectional text messaging compared to UC but is costlier. This study quantifies these extra costs to inform decision makers as to the optimal screening and communication strategy for a school population during a pandemic.