Costs and benefits of interventions aimed at major infectious disease threats: lessons from the literature

Spatiotemporal trends of Type 2 diabetes due to low physical activity from 1990 to 2019 and forecasted prevalence in 2050: A Global Burden of Disease Study 2019

BACKGROUND

Type 2 diabetes mellitus (T2DM) poses a major global health burden, yet epidemiological research on low physical activity's (LPA) impact is limited. This study examines LPA's global effect on T2DM.

METHODS

Analyzing Global Burden of Disease Database (GBD) 2019, we explored LPA-attributable T2DM deaths and Disability-Adjusted Life Years (DALYs) from 1990 to 2019, stratified by year, gender, country, and SDI regions. Estimated Annual Percentage Change (EAPC) assessed trends, and Bayesian models predicted future patterns.

RESULTS

In 2019, LPA accounted for a substantial 8.5% of T2DM deaths and 6.9% of DALYs, representing a noticeable rise since 1990. Age-standardized mortality rates (ASMR) and disability-adjusted life years rates (ASDR) increased globally, particularly in low Socio-Demographic Index (SDI) regions. High and high-middle SDI regions saw a decrease in ASMR, while all regions generally saw an upward trend in ASDR. Projections for 2050 suggest a declining ASMR but an increasing ASDR, indicating a continuing burden of T2DM despite potential mortality reductions.

CONCLUSION

LPA significantly impacts T2DM, particularly in low SDI regions. Promotion of physical activity is crucial to reduce this burden, particularly in regions where the disease's impact is most severe.

The costs of improving health emergency preparedness: A systematic review and analysis of multi-country studies

BACKGROUND

Investing in health emergency preparedness is critical to the safety, welfare and stability of communities and countries worldwide. Despite the global push to increase investments, questions remain around how much should be spent and what to focus on. We conducted a systematic review and analysis of studies that costed improvements to health emergency preparedness to help to answer these questions.

METHODS

We searched for studies that estimated the costs of improving health emergency preparedness and that were published between 1 January 2000 and 14 May 2021, using PubMed, Web of Science, Google Scholar, EconLit, and National Health Service Economic Evaluation Databases (PROSPERO CRD42021254428). We also searched grey literature repositories and contacted subject experts. We included studies that estimated the costs of improving preparedness at the global level and/or at the national level across at least ten countries, covered two or more technical areas in the WHO Benchmarks for International Health Regulations (IHR) Capacities, and included activities focused on human health. We mapped costs across technical areas in the WHO Benchmarks for IHR Capacities.

FINDINGS

Ten studies met our inclusion criteria. Costing methods varied substantially across included studies and cost estimates ranged from US$1·6 billion per year to improve capacities across 139 low- and middle-income countries (LMICs) to US$43 billion per year to support national-level activities worldwide and implement global-level initiatives, such as research and development for health technologies (diagnostics, therapeutics, and vaccines). Two recent studies estimated costs by drawing on IHR Monitoring and Evaluation Framework country capacity data, with one study estimating costs across 67 LMICs of US$15·4 billion per year (US$29·1 billion including upfront capital costs) and the other calculating costs for the 196 States Parties to the IHR of US$24·8 billion per year. Differences in included studies' methods, and the characteristics of countries considered, mean it is difficult to make like-for-like comparisons of the absolute costs or per-capita costs estimated by studies.

INTERPRETATION

Improving health emergency preparedness worldwide will require substantial and sustained increases in investments. Further guidance on estimating the size of those investments can help to standardise methods, allowing greater interpretation and comparison across studies/countries. As well as greater transparency and detail in the reporting of methods by studies focused on this topic, this can help support estimates of global resource requirements and facilitate investments towards improving preparedness for future pandemics.

FUNDING

None.

Cost-Effectiveness of Public Health Measures to Control COVID-19 in China: A Microsimulation Modeling Study

This study aimed to assess the cost-effectiveness of various public health measures in dealing with coronavirus disease 2019 (COVID-19) in China. A stochastic agent-based model was used to simulate the progress of the COVID-19 outbreak in scenario I (imported one case) and scenario II (imported four cases) with a series of public health measures. The main outcomes included the avoided infections and incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were performed to assess uncertainty. The results indicated that isolation-and-quarantine averted the COVID-19 outbreak at the lowest ICERs. The joint strategy of personal protection and isolation-and-quarantine averted one more case than only isolation-and-quarantine with additional costs. The effectiveness of isolation-and-quarantine decreased with lowering quarantine probability and increasing delay time. The strategy that included community containment would be cost-effective when the number of imported cases was >65, or the delay time of the quarantine was more than 5 days, or the quarantine probability was below 25%, based on current assumptions. In conclusion, isolation-and-quarantine was the most cost-effective intervention. However, personal protection combined with isolation-and-quarantine was the optimal strategy for averting more cases. The community containment could be more cost-effective as the efficiency of isolation-and-quarantine drops and the imported cases increases.

Costs of the COVID-19 pandemic associated with obesity in Europe: A health-care cost model

Excess weight is associated with severe outcomes of coronavirus disease 2019 (COVID-19). We aimed to estimate the total secondary care costs by body mass index (BMI, kg/m2 ) category when hospitalized due to COVID-19 in Europe during the first wave of the pandemic from January to June 2020. Building a health-care cost model, this study aimed to estimate the total costs of COVID-19. Information on risk of hospitalization, admission to intensive care unit (ICU) and risk of ventilation were based on published data. Average cost per patient and in total were calculated based on risks of admission to ICU, risk of invasive mechanical ventilation and length of hospital stay when hospitalized and published costs associated with hospitalization. The total direct costs of secondary care during the first wave of COVID-19 in Europe were estimated at EUR 13.9 billon, whereof 76% accounted for treating people with overweight and obesity. The average cost per hospital admission increased with BMI, from EUR 15831 for BMI <25 kg/m2 to EUR 30982 for BMI ≥40 kg/m2 . This study reveals that excess weight contributes disproportionally to the costs of COVID-19. This might reflect that overweight and obesity caused the COVID-19 pandemic to result in more severe outcomes for citizens and higher secondary care costs throughout Europe.