• Elena Losina, Valia Leifer, Lucia Millham, Christopher Panella, Emily P Hyle, Amir M Mohareb, Anne M Neilan, Andrea L Ciaranello, Pooyan Kazemian, and Kenneth A Freedberg.
• Brigham and Women's Hospital, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts (E.L.).
• Ann. Intern. Med. 2021 Apr 1; 174 (4): 472483472-483.

BackgroundColleges in the United States are determining how to operate safely amid the coronavirus disease 2019 (COVID-19) pandemic.ObjectiveTo examine the clinical outcomes, cost, and cost-effectiveness of COVID-19 mitigation strategies on college campuses.DesignThe Clinical and Economic Analysis of COVID-19 interventions (CEACOV) model, a dynamic microsimulation model, was used to examine alternative mitigation strategies. The CEACOV model tracks infections accrued by students and faculty, accounting for community transmissions.Data SourcesData from published literature were used to obtain parameters related to COVID-19 and contact-hours.Target PopulationUndergraduate students and faculty at U.S. colleges.Time HorizonOne semester (105 days).PerspectiveModified societal.InterventionCOVID-19 mitigation strategies, including social distancing, masks, and routine laboratory screening.Outcome MeasuresInfections among students and faculty per 5000 students and per 1000 faculty, isolation days, tests, costs, cost per infection prevented, and cost per quality-adjusted life-year (QALY).Results Of Base Case AnalysisAmong students, mitigation strategies reduced COVID-19 cases from 3746 with no mitigation to 493 with extensive social distancing and masks, and further to 151 when laboratory testing was added among asymptomatic persons every 3 days. Among faculty, these values were 164, 28, and 25 cases, respectively. Costs ranged from about $0.4 million for minimal social distancing to about $0.9 million to $2.1 million for strategies involving laboratory testing ($10 per test), depending on testing frequency. Extensive social distancing with masks cost $170 per infection prevented ($49 200 per QALY) compared with masks alone. Adding routine laboratory testing increased cost per infection prevented to between $2010 and $17 210 (cost per QALY gained, $811 400 to $2 804 600).Results Of Sensitivity AnalysisResults were most sensitive to test costs.LimitationData are from multiple sources.ConclusionExtensive social distancing with a mandatory mask-wearing policy can prevent most COVID-19 cases on college campuses and is very cost-effective. Routine laboratory testing would prevent 96% of infections and require low-cost tests to be economically attractive.Primary Funding SourceNational Institutes of Health.

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