Economic evaluation of programs against COVID-19: A systematic review

Rezapour, Aziz; Souresrafil, Aghdas; Peighambari, Mohammad Mehdi; Heidarali, Mona; Tashakori-Miyanroudi, Mahsa

doi:10.1016/j.ijsu.2020.11.015

Cited by 62 publications

(60 citation statements)

References 34 publications

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“…Compared to the scant cost-effectiveness literature on COVID-19 policy responses so far 4,5 , our study offers improvements. First, to the best of our knowledge our study is the only one that uses an ABM to simulate dynamic policy regimes that move up and down stages based on triggers of daily case numbers, and captures the large stochastic variation in how case numbers evolve.…”

Section: Discussionmentioning

confidence: 91%

“…To this point in the pandemic, a standard ‘cost-effectiveness’ analysis resting on epidemiological modelling has not been widely used with the exception of cost-effectiveness and cost-benefit studies looking at a narrow range of policy measures or focused on a particular population group (e.g., 2,3 and reviews 4,5 ). Undertaking cost effectiveness studies in a pandemic is challenging for reasons such as which perspective to use (health system only, or societal) and uncertainty in many inputs – yet be it implicit or explicit, cost-effectiveness does feature in decision-making.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Determining the optimal COVID-19 policy response using agent-based modelling linked to health and cost modelling: Case study for Victoria, Australia

Blakely

Thompson

Bablani

et al. 2021

Preprint

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BackgroundWe compared the health and economic consequences for the State of Victoria, Australia, of four COVID-19 strategies: aggressive and moderate elimination, tight suppression (aiming for 1 to 5 cases per million per day) and loose suppression (5 to 25 cases per million per day). The strategies shifted up and down through five levels of policy stringency based on the number of cases per day, for one year.MethodsAn agent-based model (ABM) generated 100 runs of daily SARS-CoV-2 case numbers, that then fed into a proportional multistate lifetable to estimate health adjusted life years (HALYs) and costs. We used a net monetary benefit approach to estimate the optimal strategy.FindingsAggressive elimination resulted in the highest percentage of days with the lowest level of restrictions (median 31.7%, 90% simulation interval 6.6% to 64.4%). However, days in hard lockdown were similar across all four strategies (medians 27.5% to 36.1%).HALY losses (compared to a no-COVID-19 scenario) were similar for moderate elimination (286, 219 to 389) and moderate elimination (314, 228 to 413), and nearly eight and 40-times higher for tight and loose suppression. The median GDP loss was least for moderate elimination ($US41.7 billion, $29.0 to $63.6 billion), but there was substantial overlap in simulation intervals between the four strategies.From a health system perspective aggressive elimination was optimal in 64% of simulations above a willingness to pay of $15,000 per HALY, followed by moderate elimination in 35% of simulations. Moderate elimination was optimal from a partial societal perspective in half the simulations followed by aggressive elimination in a quarter.Shortening the pandemic duration to 6 months saw loose suppression become preferable under a partial societal perspective.InterpretationFor this single high-income jurisdiction, elimination strategies were preferable over a 1-year pandemic duration.FundingAnonymous philanthropic donation to the University of Melbourne.Research in contextEvidence before this studyThere have been varying approaches across countries and jurisdictions as to how to manage the COVID-19 pandemic, ranging from elimination of community transmission (e.g. Australasia, Taiwan and other East Asian and Pacific Island countries) to loose suppression or mitigation that attempts to keep the case numbers within health services capacity (e.g. Sweden, USA, India, UK and some continental European countries). The best or optimal approach is unknown, and involves an invidious balancing of health, social and economic consequences of the pandemic. But it has become apparent that in high income countries using loose suppression that one still has to use lock-downs from time to time to keep case numbers within health service capacity, raising the question as to what is the best for the economy – attempting elimination, tight suppression or loose suppression?One approach to integrating the health and economic consequences is cost effectiveness analysis, but to date such approaches have mainly been focused on SARS-CoV-2 treatments rather than societal intervention, and have not incorporated a counterfactual approach to compare the same jurisdiction across the many (stochastically varying) realizations for different policy options.Added value of this studyThis study uses one high-income jurisdiction, the state of Victoria in Australia as it exited its second wave, to estimate the health and economic consequences of four policy options: aggressive and moderate elimination strategies, and tight and loose suppression strategies. The modeling is done in two steps: first, an agent-based model to simulate 100 possible trajectories of daily SARS-CoV-2 infections over one year for each of the four policy options; and second, an integrated epidemiological and economic model that estimates health and economic costs. Whilst there is considerable uncertainty in outcomes for all of the four policy options, the two elimination options are usually optimal from both a health system and a partial societal (health expenditure plus GDP cost) perspective. However, if the remaining duration of the pandemic is lessened from 1 year to half a year (as may be the case with vaccine roll-outs), loose suppression becomes more favorable – suggesting countries with already high infection rates ‘ride it out’ till vaccination coverage is adequate.

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Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Determining the optimal COVID-19 policy response using agent-based modelling linked to health and cost modelling: Case study for Victoria, Australia

Blakely

Thompson

Bablani

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…We read with great interest the article published in your prestigious journal by Rezapour et al [ 1 ], where the authors carried out a systematic review with the aim of summarizing the evidence of the economic evaluation of the COVID 19 prevention strategies, programs, and treatments [ 1 ].…”

mentioning

confidence: 99%

“…The results of the study suggest that screening and social distancing are cost-effective alternatives for long-term prevention and control of COVID-19, and it found that the use of personal protective equipment is cost-effective in the short term compared to not performing any intervention [ 1 ]. However, during the systematic review, no data related to studies in Latin America were presented, and it is necessary to contrast the evidence from all regions of the world, to evaluate the applicability of the strategies, programs and treatments mentioned, considering that there are social, economic, political and health policy differences between Latin America and other regions of the world.…”

mentioning

confidence: 99%

A commentary on “Economic evaluation of programs against COVID-19: A systematic review”

Camargo-Martínez

Escobar-Collazos

Lozada-Martínez

et al. 2021

International Journal of Surgery

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“…If so, prevention and containment of the ongoing epidemic can be challenging, not only in China but also in other countries. Rezapour et al [ 3 ] reviewed twenty-six studies to summarize economic evaluation evidence of preventing strategies, programs, and treatments of COVID-19. The results suggested screening tests and social distancing to be cost-effective alternatives in preventing and controlling COVID-19 on a long-time horizon.…”

mentioning

confidence: 99%

A commentary on “Economic evaluation of programs against COVID-19: A systematic review”

Ding¹,

Li²

2021

International Journal of Surgery

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Economic evaluation of programs against COVID-19: A systematic review

Cited by 62 publications

References 34 publications

Determining the optimal COVID-19 policy response using agent-based modelling linked to health and cost modelling: Case study for Victoria, Australia

Determining the optimal COVID-19 policy response using agent-based modelling linked to health and cost modelling: Case study for Victoria, Australia

A commentary on “Economic evaluation of programs against COVID-19: A systematic review”

A commentary on “Economic evaluation of programs against COVID-19: A systematic review”

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