Cost-effectiveness of public health strategies for COVID-19 epidemic control in South Africa: a microsimulation modelling study

Abstract

Background Health-care resource constraints in low-income and middle-income countries necessitate the identification of cost-effective public health interventions to address COVID-19. We aimed to develop a dynamic COVID-19 microsimulation model to assess clinical and economic outcomes and cost-effectiveness of epidemic control strategies in KwaZulu-Natal province, South Africa. Methods We compared different combinations of five public health interventions: health-care testing alone, where diagnostic testing is done only for individuals presenting to health-care centres; contact tracing in households of cases; isolation centres, for cases not requiring hospital admission; mass symptom screening and molecular testing for symptomatic individuals by community health-care workers; and quarantine centres, for household contacts who test negative. We calibrated infection transmission rates to match effective reproduction number ( R e ) estimates reported in South Africa. We assessed two main epidemic scenarios for a period of 360 days, with an R e of 1·5 and 1·2. Strategies with incremental cost-effectiveness ratio (ICER) of less than US$3250 per year of life saved were considered cost-effective. We also did sensitivity analyses by varying key parameters ( R e values, molecular testing sensitivity, and efficacies and costs of interventions) to determine the effect on clinical and cost projections. Findings When R e was 1·5, health-care testing alone resulted in the highest number of COVID-19 deaths during the 360-day period. Compared with health-care testing alone, a combination of health-care testing, contact tracing, use of isolation centres, mass symptom screening, and use of quarantine centres reduced mortality by 94%, increased health-care costs by 33%, and was cost-effective (ICER $340 per year of life saved). In settings where quarantine centres were not feasible, a combination of health-care testing, contact tracing, use of isolation centres, and mass symptom screening was cost-effective compared with health-care testing alone (ICER $590 per year of life saved). When R e was 1·2, health-care testing, contact tracing, use of isolation centres, and use of quarantine centres was the least costly strategy, and no other strategies were cost-effective. In sensitivity analyses, a combination of health-care testing, contact tracing, use of isolation centres, mass symptom screening, and use of quarantine centres was generally cost-effective, with the exception of scenarios in which R e was 2·6 and when efficacies of isolation centres and quarantine centres for transmission reduction were reduced. Interpretation In South Africa, strategies involving household contact trac...

Detection of SARS-CoV-2 by antigen ELISA test is highly swayed by viral load and sample storage condition

“…Several underdeveloped or developing countries are at a disadvantage due to the lack of quality laboratory setup, proper sample handling tools, safety equipment such as personal protective equipment (PPE) and well-trained laboratory personnel [12][13][14]. Furthermore, the high-cost RT-qPCR test is in contention of being an economic burden for the low or mid-income population [15,16]. Besides, a moderate-to-high rate of false-negative results and recent claims about false-positive results of SARS-CoV-2 RT-qPCR created unintended complications in diagnosing the disease [17,18].…”

Cost-effectiveness of COVID-19 vaccination in low- and middle-income countries

“…This analysis has several limitations. First, natural history inputs were originally derived and validated as part of an analysis based in South Africa 8 . We used inputs calibrated to data from South Africa for three reasons: 1) accurate IFR data from other countries, particularly many LMICs, is limited; 2) age is well-established as the greatest risk factor for COVID-19 mortality and, after accounting for age, additional co-morbidities appear to have little additional effect on expected and reported mortality in LMICs 46,47 ; and 3) use of data from South Africa is likely to more closely reflect SARS-CoV-2 natural history estimates in LMICs than data from high-income countries.…”

“…We used the Clinical and Economic Analysis of COVID-19 interventions (CEACOV) model, a validated, dynamic microsimulation of the natural history of COVID-19 8,25–27 (Supplementary Methods and Supplementary Fig. 1).…”

“…Further, the optimal vaccine supply is unknown and the cost-effectiveness of investments into global vaccination programs has not been described. We used a validated COVID-19 simulation model 8 to project the health benefits and costs of reaching 20%-70% vaccine coverage in 91 LMICs. We show that funding 20% vaccine coverage over one year among 91 LMICs would prevent 294 million infections and 2 million deaths, with 26 million years of life saved at a cost of US$6.4 billion, for an incremental cost effectiveness ratio (ICER) of US$250/year of life saved (YLS).…”

Potential impact of intervention strategies on COVID-19 transmission in Malawi: a mathematical modelling study

“…17 41 42 Additional interventions, such as testing (test, trace and isolate) and local quarantining, could have a significant impact on the spread of infection and have been regularly used for casefinding and containment for HIV and TB in low-income and middle-income countries. [43][44][45][46] However, they are extremely intensive and difficult to implement at a large scale and therefore may not be a feasible option for mitigating the outbreak in Malawi.…”