C19 Health Economics Literature

The epidemiological situation generated by COVID-19 has highlighted the importance of applying non-pharmacological measures. Among these, mass screening of the asymptomatic general population has been established as a priority strategy by carrying out diagnostic tests to limit the spread of the virus. In this article, we aim to evaluate the economic impact of mass COVID-19 screenings of an asymptomatic population through a Cost-Benefit Analysis based on the estimated total costs of mass screening versus health gains and associated health costs avoided. Excluding the value of monetized health, the Benefit-Cost ratio was estimated at approximately 0.45. However, if monetized health is included in the calculation, the ratio is close to 1.20. The monetization of health is the critical element that tips the scales in favour of the desirability of screening. Screenings with the highest...

Objectives To evaluate the cost effectiveness of an asymptomatic SARS-CoV-2 whole area testing pilot. Design Epidemiological modelling and cost effectiveness analysis. Setting The community of Merthyr Tydfil County Borough between20 Nov and 21 Dec 2020. Participants A total of 33,822 people tested as part of the pilot in Merthyr Tydfil County Borough, 712 of whom tested positive by lateral flow test and reported being asymptomatic. Main outcome measures Estimated number of cases, hospitalisations, ICU admissions and deaths prevented, and associated costs per quality-adjusted life years (QALYs) gained and monitory cost to the healthcare system. Results An initial conservative estimate of 360 (95% CI: 311 – 418) cases were prevented by the mass testing, representing a would-be reduction of 11% of all cases diagnosed in Merthyr Tydfil residents during the same period....

High frequency screening of populations has been proposed as a strategy in facilitating control of the COVID-19 pandemic. We use computational modeling, coupled with clinical data from rapid antigen tests, to predict the impact of frequent viral antigen rapid testing on COVID-19 spread and outcomes. Using patient nasal or nasopharyngeal swab specimens, we demonstrate that the sensitivity/specificity of two rapid antigen tests compared to quantitative real-time polymerase chain reaction (qRT-PCR) are 82.0%/100% and 84.7%/85.7%, respectively; moreover, sensitivity correlates directly with viral load. Based on COVID-19 data from three regions in the United States and São José do Rio Preto, Brazil, we show that high frequency, strategic population-wide rapid testing, even at varied accuracy levels, diminishes COVID-19 infections, hospitalizations, and deaths at a fraction of the...

  COVID-19 has caused an enormous burden on healthcare facilities around the world. Cohorting patients and healthcare professionals (HCPs) into “bubbles” has been proposed as an infection-control mechanism. In this paper, we present a novel and flexible model for clustering patient care in healthcare facilities into bubbles in order to minimize infection spread. Our model aims to control a variety of costs to patients/residents and HCPs so as to avoid hidden, downstream adverse effects of clustering patient care. This model leads to a discrete optimization problem that we call the BubbleClustering problem. This problem takes as input a temporal visit graph, representing HCP mobility, including visits by HCPs to patient/resident rooms. The output of the problem is a rewired visit graph, obtained by partitioning HCPs and patient rooms into bubbles and rewiring HCP visits to patient...

For mitigating the COVID-19 pandemic, much emphasis is made on implementing non-pharmaceutical interventions to keep the reproduction number below one. However, using that objective ignores that some of these interventions, like bans of public events or lockdowns, must be transitory and as short as possible because of their significant economic and societal costs. Here, we derive a simple and mathematically rigorous criterion for designing optimal transitory non-pharmaceutical interventions for mitigating epidemic outbreaks. We find that reducing the reproduction number below one is sufficient but not necessary. Instead, our criterion prescribes the required reduction in the reproduction number according to the desired maximum of disease prevalence and the maximum decrease of disease transmission that the interventions can achieve. We study the implications of our theoretical...

Low- and middle-income countries are implementing COVID-19 vaccination strategies in light of varying and uncertain vaccine efficacies and costs, supply shortages, and resource constraints. We used a microsimulation model to evaluate clinical outcomes and cost-effectiveness of a COVID-19 vaccination program in South Africa. We varied vaccination coverage, pace, acceptance, effectiveness, and cost as well as epidemic dynamics. Providing vaccine to at least 40% of the population and prioritizing accelerated vaccine rollout prevented >9 million infections and >73,000 deaths and reduced costs due to fewer hospitalizations. Further, the vaccination program was cost-saving even at the lowest examined levels of acceptance (50%), effectiveness against infection (20%), effectiveness against symptomatic disease (30%), and effectiveness against severe/critical disease requiring hospitalization...

Brazil represents a tragic example of how lack of appropriate policies and pandemic denial impact public health. The country of 212 million inhabitants (3% of the world population) recorded around 1/3 of all daily COVID-19 deaths worldwide in late March 2021 [1]. Brazil’s brutal surge in COVID-19 deaths in the first months of 2021 has been climbing steadily, reaching over 4000 fatalities/day in early April, as a consequence of the widespread of the new variants overwhelming hospitals. In spite of the alarming scenario, the federal government is not yet adopting evidence-based and reliable public health measures, such as use of masks and social distancing.Brazil’s public health system provides healthcare for 78% of the population. Its free, publicly funded national vaccination program has an excellent track record: 96% of the population is vaccinated against TB, diphtheria, polio...

A mathematical model of COVID-19 is presented where the decision to increase or decrease social distancing is modelled dynamically as a function of the measured active and total cases as well as the perceived cost of isolating. Along with the cost of isolation, we define an overburden healthcare cost and a total cost. We explore these costs by adjusting parameters that could change with policy decisions. We observe that two disease prevention practices, namely increasing isolation activity and increasing incentive to isolate do not always lead to optimal health outcomes. We demonstrate that this is due to the fatigue and cost of isolation. We further demonstrate that an increase in the number of lock-downs, each of shorter duration can lead to minimal costs. Our results are compared with case data in Ontario, Canada from March to August 2020 and details of expanding the results to...

Background: The economic stimulus package in the United States, which totalled $2.48 trillion, was designed to soften the economic impact of sweeping containment measures including shelter-in-place orders that were put in place to control the COVID-19 pandemic.Methods: In healthcare, interventions are rarely justified simply in terms of the number of lives saved but also in terms of a myriad of other trade-off factors including value-for-money or cost-effectiveness. Cost-effectiveness analysis was therefore conducted as the cost per life-year gained (Cost/LYG) from the containment measures adopted based on several different projections of the baseline number of deaths in the absence of any containment measures. Reductions in premature mortality due to the shutdown (i.e. the difference between years of life lost relative to life expectancy under the shutdown and no shutdown...