Background COVID-19, an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), swept through China in 2019-2020, with over 80,000 confirmed cases reported by end of March 2020. This study estimates the economic burden of COVID-19 in 31 provincial-level administrative regions in China between January and March 2020. Methods The healthcare and societal cost of COVID-19 was estimated using bottom-up approach. The main cost components included identification, diagnosis and treatment of COVID-19, compulsory quarantine and productivity losses for all affected residents in China during the study period. Input data were obtained from government reports, clinical guidelines, and other published literature. The primary outcomes were total health and societal costs. Costs were reported in both RMB and USD (2019 value). Outcomes The total estimated healthcare...
Background: Movement restriction policies (MRPs) are effective in preventing/delaying COVID-19 transition but are associated with high societal cost. This study aims to estimate the health burden of the first wave of COVID-19 in China, and the cost-effectiveness of early versus late implementation of MRPs so to inform preparation for future waves. Methods: The SEIR (susceptible, exposed, infectious and recovered) modelling framework was adapted to simulate the health and cost outcomes of initiating MRPs at different times: rapid implementation (23 rd January, the real-world scenario), delayed by one week, delayed by two weeks and delayed by four weeks. The end point was set as the day when newly confirmed cases reached zero. Two costing perspectives were adopted: healthcare and societal. Input data were obtained from official statistics and published literature. The primary outcomes...
The issue of the cost effectiveness of measures taken to tackle COVID-19 are discussed in a BMJ feature article by John Appleby, director of research and chief economist at Nuffield Trust in the UK.Appleby notes that whilst it is hard to discuss the economics of COVID-19 whilst in the midst of an “unprecedented global emergency” during which measures are being taken to minimise mortality and morbidity, the question of cost benefit is one that all health systems routinely face. Although determining cost effectiveness may be viewed as a somewhat “heartless utilitarian” process, it is essentially concerned with fair use of scarce resources. However, this can be hard to apply when rescuing people in emergency situations, which leads Appleby to raise the question “does cost effectiveness even have a role when it comes to covid-19 − undeniably an emergency?”.Although modelling has...
Background: Countries can decide between one of three COVID-19 control strategies: 1) elimination (e.g., some island countries); 2) suppression, to low infection rates; 3) or mitigation, as per pandemic influenza strategies with ensuing herd immunity. This paper quantifies the health (direct COVID-19 impact, and indirect through unemployment onto self-harm and road traffic crash) and cost (health system and societal) consequences for these strategies across Australia, New Zealand (NZ) and Sweden. Methods: We used proportional multistate lifetable (PMSLT) models for each country, with mortality and morbidity data from the Global Burden of Disease Study and health system expenditure from country-specific sources. Feeding into the PMSLT were monthly SARS-CoV-2 infection rates (0.1%/2.5%/60% for elimination/suppression/mitigation by 18 months), and anticipated changes in unemployment...
There has been considerable public debate about whether the economic impact
of the current COVID19 restrictions are worth the costs. Although the potential
impact of COVID19 has been modelled extensively, very few numbers have been
presented in the discussions about potential economic impacts. For a good
answer to the question – will the restrictions cause as much harm as COVID19? –
credible evidence-based estimates are required, rather than simply rhetoric.
Here we provide some preliminary estimates to compare the impact of the current
restrictions against the direct impact of the virus. Since most countries are
currently taking an approach that reduces the number of COVID19 deaths, the
estimates we provide for deaths from COVID19 are deliberately taken from the
low end of the estimates of the infection fatality rate, while estimates for
deaths from an economic recession...
During the COVID-19 crisis there have been many difficult decisions
governments and other decision makers had to make. E.g. do we go for a total
lock down or keep schools open? How many people and which people should be
tested? Although there are many good models from e.g. epidemiologists on the
spread of the virus under certain conditions, these models do not directly
translate into the interventions that can be taken by government. Neither can
these models contribute to understand the economic and/or social consequences
of the interventions. However, effective and sustainable solutions need to take
into account this combination of factors. In this paper, we propose an
agent-based social simulation tool, ASSOCC, that supports decision makers
understand possible consequences of policy interventions, bu exploring the
combined social, health and economic consequences of...
With a two-layer contact-dispersion model and data in China, we analyze the
cost-effectiveness of three types of antiepidemic measures for COVID-19:
regular epidemiological control, local social interaction control, and
inter-city travel restriction. We find that: 1) intercity travel restriction
has minimal or even negative effect compared to the other two at the national
level; 2) the time of reaching turning point is independent of the current
number of cases, and only related to the enforcement stringency of
epidemiological control and social interaction control measures; 3) strong
enforcement at the early stage is the only opportunity to maximize both
antiepidemic effectiveness and cost-effectiveness; 4) mediocre stringency of
social interaction measures is the worst choice. Subsequently, we cluster
countries/regions into four groups based on their control measures and...
In this paper, we predict the health and economic consequences of immediate investment in personal protective equipment (PPE) for health care workers (HCWs) in low- and middle-income countries (LMICs). An investment of $3.485 billion USD would adequately protect HCWs in all LMICs. This intervention saves 789,557 (95% CI: 741,905 to 837,209) lives across LMICs, costing $418 USD per HCW case averted and $4,448 USD per HCW life saved. The societal return on investment (ROI) is $241.1 billion USD, the equivalent of a 6,918% return. Regional and national estimates are also presented. In scenarios where PPE remains scarce, 70-100% of HCWs will get infected, irrespective of nationwide social distancing policies. Maintaining HCW infection rates below 10% and mortality below 1% requires inclusion of a PPE scale-up strategy as part of the pandemic response. In conclusion, wide-scale...
Background The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was first reported in China, which caused a respiratory disease known as Coronavirus Disease 2019 (COVID-19). Since its discovery, the virus has spread to over 100 countries and claimed more than 4000 deaths. This study aimed to assess the effectiveness and cost-effectiveness of various response public health measures. Method The stochastic agent-based model was used to simulate the process of COVID-19 outbreak in scenario I (imported one case) and II (imported four cases) with a series of public health measures, involving the personal protection, isolation-and-quarantine, gathering restriction, and community containment. The virtual community was constructed following the susceptible-latent-infectious-recovered framework. The epidemiological and economic parameters derived from the previous literature and...