Disease Burden Attributable to the First Wave of COVID-19 in China and the Effect of Timing on the Cost-Effectiveness of Movement Restriction Policies

The role of economic evaluation in modelling public health and social measures for pandemic policy: a systematic review

BACKGROUND

Dynamic transmission models are often used to provide epidemiological guidance for pandemic policy decisions. However, how economic evaluation is typically incorporated into this technique to generate cost-effectiveness estimates of pandemic policy responses has not previously been reviewed.

METHODS

We systematically searched the Embase, PubMed and Scopus databases for dynamic epidemiological modelling studies that incorporated economic evaluation of public health and social measures (PHSMs), with no date restrictions, on 7 July 2024.

RESULTS

Of the 2,719 screened studies, 51 met the inclusion criteria. Most studies (n = 42, 82%) modelled SARS-CoV-2. A range of PHSMs were examined, including school closures, testing/screening, social distancing and mask use. Half of the studies utilised an extension of a Susceptible-Exposed-Infectious-Recovered (SEIR) compartmental model. The most common type of economic evaluation was cost-effectiveness analysis (n = 24, 47%), followed by cost-utility analysis (n = 17, 33%) and cost-benefit analysis (n = 17, 33%).

CONCLUSIONS

Economic evaluation is infrequently incorporated into dynamic epidemiological modelling studies of PHSMs. The scope of this research should be expanded, given the substantial cost implications of pandemic PHSM policy responses.

The impact of COVID-19 pandemic lockdowns on air quality index: a systematic review

During the outbreak of the novel coronavirus disease 2019 (COVID-19), many countries implemented lockdown policies to control its transmission. These restrictions provided an opportunity to rest and recover the environment. This systematic review (SR) aimed to evaluate the impact of COVID-19 lockdowns on the Air Quality Index (AQI) in countries worldwide. ScienceDirect and PubMed were searched using relevant keywords to identify studies published until March 2020. Overall, 20 studies were included in the SR based on the eligibility criteria. The results show that COVID-19-related lockdown policies positively affect AQI by restricting air-polluting activities, such as transportation, industry, and construction. However, it is important to note that these policies are ineffective in controlling sources of natural air pollution and local dust. The findings of this study emphasize the need for policymakers to approve legislation limiting the sources of air pollutants.

The global economic burden of COVID-19 disease: a comprehensive systematic review and meta-analysis

BACKGROUND

The COVID-19 pandemic has caused a considerable threat to the economics of patients, health systems, and society.

OBJECTIVES

This meta-analysis aims to quantitatively assess the global economic burden of COVID-19.

METHODS

A comprehensive search was performed in the PubMed, Scopus, and Web of Science databases to identify studies examining the economic impact of COVID-19. The selected studies were classified into two categories based on the cost-of-illness (COI) study approach: top-down and bottom-up studies. The results of top-down COI studies were presented by calculating the average costs as a percentage of gross domestic product (GDP) and health expenditures. Conversely, the findings of bottom-up studies were analyzed through meta-analysis using the standardized mean difference.

RESULTS

The implemented search strategy yielded 3271 records, of which 27 studies met the inclusion criteria, consisting of 7 top-down and 20 bottom-up studies. The included studies were conducted in various countries, including the USA (5), China (5), Spain (2), Brazil (2), South Korea (2), India (2), and one study each in Italy, South Africa, the Philippines, Greece, Iran, Kenya, Nigeria, and the Kingdom of Saudi Arabia. The results of the top-down studies indicated that indirect costs represent 10.53% of GDP, while the total estimated cost accounts for 85.91% of healthcare expenditures and 9.13% of GDP. In contrast, the bottom-up studies revealed that the average direct medical costs ranged from US $1264 to US $79,315. The meta-analysis demonstrated that the medical costs for COVID-19 patients in the intensive care unit (ICU) were approximately twice as high as those for patients in general wards, with a range from 0.05 to 3.48 times higher.

CONCLUSIONS

Our study indicates that the COVID-19 pandemic has imposed a significant economic burden worldwide, with varying degrees of impact across countries. The findings of our study, along with those of other research, underscore the vital role of economic consequences in the post-COVID-19 era for communities and families. Therefore, policymakers and health administrators should prioritize economic programs and accord them heightened attention.

The optimisation of public health emergency governance: a simulation study based on COVID-19 pandemic control policy

BACKGROUND

The outbreak of the COVID-19 pandemic sparked numerous studies on policy options for managing public health emergencies, especially regarding how to choose the intensity of prevention and control to maintain a balance between economic development and disease prevention.

METHODS

We constructed a cost-benefit model of COVID-19 pandemic prevention and control policies based on an epidemic transmission model. On this basis, numerical simulations were performed for different economies to analyse the dynamic evolution of prevention and control policies. These economies include areas with high control costs, as seen in high-income economies, and areas with relatively low control costs, exhibited in upper-middle-income economies.

RESULTS

The simulation results indicate that, at the outset of the COVID-19 pandemic, both high-and low-cost economies tended to enforce intensive interventions. However, as the virus evolved, particularly in circumstances with relatively rates of reproduction, short incubation periods, short spans of infection and low mortality rates, high-cost economies became inclined to ease restrictions, while low-cost economies took the opposite approach. However, the consideration of additional costs incurred by the non-infected population means that a low-cost economy is likely to lift restrictions as well.

CONCLUSIONS

This study concludes that variations in prevention and control policies among nations with varying income levels stem from variances in virus transmission characteristics, economic development, and control costs. This study can help researchers and policymakers better understand the differences in policy choice among various economies as well as the changing trends of dynamic policy choices, thus providing a certain reference value for the policy direction of global public health emergencies.

Cost-effectiveness of Paxlovid in reducing severe COVID-19 and mortality in China

Objectives

To assess the cost-effectiveness of Paxlovid in reducing severe COVID-19 and its associated morality, and to investigate the affordable price of Paxlovid in China.

Materials and methods

Using a Markov model, two interventions by Paxlovid prescription (with and without prescription) were compared in terms of COVID-19-related clinical outcomes and economic loss. COVID-related costs were collected from the societal perspective. Effectiveness data were obtained from literature. The primary outcomes were total social cost, disability adjusted life-years (DALYs) and net monetary benefit (NMB). Scenario analyses were performed to investigate the affordable price of Paxlovid in China. Deterministic sensitivity analyses (DSA) and probabilistic sensitivity analysis (PSA) were performed to verify the model robustness.

Results

Compared with the non-Paxlovid cohort, the NMBs of the Paxlovid cohort were only higher in the subgroup of patients aged over 80 years old, regardless of their vaccination status. Our scenario analysis found that, the price ceiling of Paxlovid/box for it to be cost-effective was RMB 8,993 (8,970-9,009) in those aged over 80 years old who were not vaccinated, which is the highest; and was RMB 35 (27-45) in those aged 40-59 years old who were vaccinated, which is the lowest. Sensitivity analyses found that the incremental NMB for the vaccinated people aged over 80 years was most sensitive to the efficacy of Paxlovid and the cost-effectiveness probability of Paxlovid increased with its decreasing price.

Conclusion

Under the current marketing price of Paxlovid/box (RMB 1,890), using Paxlovid was only cost-effective in people aged over 80 years old regardless of their vaccination status.

The FLURESP European commission project: cost-effectiveness assessment of ten public health measures against influenza in Italy: is there an interest in COVID-19 pandemic?

BACKGROUND

The FLURESP project is a public health research funded by the European Commission, with the objective to design a methodological framework to assess the cost-effectiveness of existing public health measures against human influenza pandemics. A dataset has been specifically collected in the frame of the Italian health system. As most of interventions against human influenza are relavant against other respiratory diseases pandemics, potential interests in COVID-19 are discussed.

METHODS

Ten public health measures against human influenza pandemics pandemic were selected to be also relevant to other respiratory virus pandemics such as COVID 19: individual (hand washing, using masks), border control (quarantine, fever screening, border closure), community infection (school closure, class dismissal, social distancing, limitation of public transport), reduction of secondary infections (implementation of antibiotic therapy guidelines), pneumococcal vaccination for at-risk people, development of Intensive Care Unit (ICU) capacity, implementation of life support equipments in ICU, screening interventions, vaccination programs targeting health professional and targeting general population.

RESULTS

Using mortality reduction as effectiveness criteria, the most cost-effective strategies are "reduction of secondary infections" and "implementation of life support equipment in ICU". The least cost-effective option whatever the level of pandemic events are screening interventions and mass vaccination.

CONCLUSIONS

A number of intervention strategies against human influenza pandemics appears relevant against every respiratory virus, including the COVID-19 event. Measures against pandemics should be considered according to their expected effectiveness but also their costs for the society because they impose substantial burden to the population, confirming the interest of considering cost-effectiveness of public health measures to enlighten decision making.

Cost-effectiveness analysis of COVID-19 screening strategy under China's dynamic zero-case policy

This study aims to optimize the COVID-19 screening strategies under China's dynamic zero-case policy through cost-effectiveness analysis. A total of 9 screening strategies with different screening frequencies and combinations of detection methods were designed. A stochastic agent-based model was used to simulate the progress of the COVID-19 outbreak in scenario I (close contacts were promptly quarantined) and scenario II (close contacts were not promptly quarantined). The primary outcomes included the number of infections, number of close contacts, number of deaths, the duration of the epidemic, and duration of movement restriction. Net monetary benefit (NMB) and the incremental cost-benefit ratio were used to compare the cost-effectiveness of different screening strategies. The results indicated that under China's COVID-19 dynamic zero-case policy, high-frequency screening can help contain the spread of the epidemic, reduce the size and burden of the epidemic, and is cost-effective. Mass antigen testing is not cost-effective compared with mass nucleic acid testing in the same screening frequency. It would be more cost-effective to use AT as a supplemental screening tool when NAT capacity is insufficient or when outbreaks are spreading very rapidly.

Impact of COVID-19 outbreak on the mental health in sports: a review

Global pandemic, lockdown restrictions, and COVID-19 compulsory social isolation guidelines have raised unprecedented mental health in the sports community. The COVID-19 pandemic is found to affect the mental health of the population. In critical situations, health authorities and sports communities must identify their priorities and make plans to maintain athletes' health and athletic activities. Several aspects play an important role in prioritization and strategic planning, e.g., physical and mental health, distribution of resources, and short to long-term environmental considerations. To identify the psychological health of sportspeople and athletes due to the outbreak of COVID-19 has been reviewed in this research. This review article also analyzes the impact of COVID-19 on health mental in databases. The COVID-19 outbreak and quarantine would have a serious negative impact on the mental health of athletes. From the accessible sources, 80 research articles were selected and examined for this purpose such as Research Gate, PubMed, Google Scholar, Springer, Scopus, and Web of Science and based on the involvement for this study 14 research articles were accessed. This research has an intention on mental health issues in athletes due to the Pandemic. This report outlines the mental, emotional and behavioural consequences of COVID-19 home confinement. Further, research literature reported that due to the lack of required training, physical activity, practice sessions, and collaboration with teammates and coaching staff are the prime causes of mental health issues in athletes. The discussions also reviewed several pieces of literature which examined the impacts on sports and athletes, impacts on various countries, fundamental issues of mental health and the diagnosis for the sports person and athletes, and the afterlife of the COVID-19 pandemic for them. Because of the compulsory restrictions and guidelines of this COVID-19 eruption, the athletes of different sports and geographical regions are suffering from fewer psychological issues which were identified in this paper. Accordingly, the COVID-19 pandemic appears to negatively affect the mental health of the athletes with the prevalence and levels of anxiety and stress increasing, and depression symptoms remaining unaltered. Addressing and mitigating the negative effect of COVID-19 on the mental health of this population identified from this review.

Dynamic zero-COVID strategy in controlling COVID-19 in Shanghai, China: A cost-effectiveness analysis

BACKGROUND

The sustainability and generalizability of China's dynamic zero-COVID strategy on eliminating SARS-CoV-2 transmission has casted doubt globally, mainly because it has exacted high social and economic cost. This study aimed to estimate the disease burden during the first wave of Omicron in China and compared the cost-effectiveness of implementing a Real-world strategy (adjusted dynamic zero-COVID strategy) with two simulated strategies (routine and stricter dynamic zero-COVID strategy) to inform appropriate strategies for COVID-19 pandemic control.

METHODS

A dynamic state-transition simulation model was developed to compare the health and cost outcomes between different dynamic zero-COVID strategies. Omicron-related healthcare costs were estimated from the societal perspective. Epidemiological parameter values were derived from data of real-world or generated by model calibration; costs and effectiveness parameter values were informed either by local data or published literature. The primary outcomes were total social cost, disability adjusted life-years (DALYs) and net monetary benefit (NMB). Deterministic sensitivity analyses (DSA) and scenario analyses were performed to assess the model robustness.

RESULTS

The first wave of Omicron in Shanghai resulted in 47,646 DALYs lost and 415 billion RMB losses. At a willingness-to-pay threshold of 173,630 RMB (the GDP per capita of Shanghai in 2021) per DALY saved, the Real-world strategy was considered as the most cost-effective strategy due to its highest NMB (-407 billion). Results from DSA confirmed the robustness of our findings.

CONCLUSION

Our finding supported the Real-world strategy taken by the Shanghai Municipal Government between March 1 and May 21, 2022 to control the first wave of Omicron outbreak. Moreover, our results indicated that whether the Stricter dynamic zero-COVID strategy is worth implementing at the beginning of the COVID-19 outbreak mainly depended on the infection rate of COVID-19 among primary contacts. Our analysis provides important evidence to inform policy makers to make appropriate decisions regarding COVID-19 pandemic management.

Burden of COVID‐19 disease in Kurdistan province in west of Iran using disability‐adjusted life years

Background and Aims

During the coronavirus disease 2019 (COVID‐19) pandemic, about seven million people were infected with the disease, of which more than 133,000 died. Health policymakers need to know the extent and magnitude of the disease burden to decide on how much to allocate resources for disease control. The results of this investigation could be helpful in this field.

Methods

We used the secondary data released by the Kurdistan University of Medical Sciences between February 2020 to October 2021 to estimate the age‐sex standardized disability‐adjusted life years (DALY) by the sum of the years of life lived with disability (YLD) and the years of life lost (YLL). We also applied the local and specific values of the disease utility in the calculations.

Results

The total DALY was estimated at 23316.5 and 1385.5 per 100,000 populations The YLD and YLL constituted 1% and 99% of the total DALY, respectively. The DALY per 100,000 populations was highest in the men and people aged more than 65 years, but the prevalence was the highest in people under the age of 40.

Conclusions

Compared to the findings of the “burden of disease study 2019,” the burden of COVID‐19 in Iran is ranked first and eighth among communicable and noncommunicable diseases, respectively. Although the disease affects all groups, the elderly suffer the most from it. Given the very high YLL of COVID‐19, the best strategy to reduce the burden of COVID‐19 in subsequent waves should be to focus on preventing infection in the elderly population and reducing mortality.

Economic evaluation of strategies against coronavirus: a systematic review

BACKGROUND

The COVID-19 outbreak was defined as a pandemic on 11 March 2020 by the World Health Organization. After that, COVID-19 has enormously influenced health systems around the world, and it has claimed more than 4.2 million deaths until July 2021. The pandemic has led to global health, social and economic costs. This situation has prompted a crucial search for beneficial interventions and treatments, but little is known about their monetary value. This study is aimed at systematically reviewing the articles conducted on the economic evaluation of preventive, control and treatment strategies against COVID-19.

MATERIAL AND METHOD

We searched PubMed, Web of Science, Scopus, and Google Scholar from December 2019 to October 2021 to find applicable literature to the economic evaluation of strategies against COVID-19. Two researchers screened potentially eligible titles and abstracts. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used to quality assessment of studies.

RESULTS

Thirty-six studies were included in this review, and the average CHEERS score was 72. Cost-effectiveness analysis was the most common type of economic evaluation, used in 21 studies. And the quality-adjusted life year (QALY) was the main outcome applied to measure the effectiveness of interventions, which was used in 19 studies. In addition, articles were reported a wide range of incremental cost-effectiveness ratio (ICER), and the lowest cost per QALY ($321.14) was related to the use of vaccines.

CONCLUSION

Based on the results of this systematic review, it seems that all strategies are likely to be more cost-effective against COVID-19 than no intervention and vaccination was the most cost-effective strategy. This research provides insight for decision makers in choosing optimal interventions against the next waves of the current pandemic and possible future pandemics.

Treatment cost assessment for COVID-19 inpatients in Shenzhen, China 2020-2021: facts and suggestions

Background

Knowledge regarding the treatment cost of coronavirus disease 2019 (COVID-19) in the real world is vital for disease burden forecasts and health resources planning. However, it is greatly hindered by obtaining reliable cost data from actual patients. To address this knowledge gap, this study aims to estimate the treatment cost and specific cost components for COVID-19 inpatients in Shenzhen city, China in 2020-2021.

Methods

It is a 2 years' cross-sectional study. The de-identified discharge claims were collected from the hospital information system (HIS) of COVID-19 designated hospital in Shenzhen, China. One thousand three hundred ninety-eight inpatients with a discharge diagnosis for COVID-19 from January 10, 2020 (the first COVID-19 case admitted in the hospital in Shenzhen) to December 31, 2021. A comparison was made of treatment cost and cost components of COVID-19 inpatients among seven COVID-19 clinical classifications (asymptomatic, mild, moderate, severe, critical, convalescent and re-positive cases) and three admission stages (divided by the implementation of different treatment guidelines). The multi-variable linear regression models were used to conduct the analysis.

Results

The treatment cost for included COVID-19 inpatients was USD 3,328.8. The number of convalescent cases accounted for the largest proportion of all COVID-19 inpatients (42.7%). The severe and critical cases incurred more than 40% of treatment cost on western medicine, while the other five COVID-19 clinical classifications spent the largest proportion (32%-51%) on lab testing. Compared with asymptomatic cases, significant increases of treatment cost were observed in mild cases (by 30.0%), moderate cases (by 49.2%), severe cases (by 228.7%) and critical cases (by 680.7%), while reductions were shown in re-positive cases (by 43.1%) and convalescent cases (by 38.6%). The decreasing trend of treatment cost was observed during the latter two stages by 7.6 and 17.9%, respectively.

Conclusions

Our findings identified the difference of inpatient treatment cost across seven COVID-19 clinical classifications and the changes at three admission stages. It is highly suggestive to inform the financial burden experienced by the health insurance fund and the Government, to emphasize the rational use of lab tests and western medicine in the COVID-19 treatment guideline, and to design suitable treatment and control policy for convalescent cases.

Cost-Effectiveness of COVID-19 Sequential Vaccination Strategies in Inactivated Vaccinated Individuals in China

To effectively prevent and control the COVID-19 pandemic, countries have adopted a booster vaccination strategy. This study aimed to estimate the cost-effectiveness of sequential booster COVID-19 vaccination compared to two-dose inactivated vaccination in China from a societal perspective. A Markov model was developed to estimate the cost-effectiveness of sequential vaccination, including two doses of an inactivated vaccine followed by a booster shot of an inactivated vaccine, adenovirus vectored vaccine, protein subunit vaccine, or mRNA vaccine. The incremental effects of a booster shot with an inactivated vaccine, protein subunit vaccine, adenovirus vectored vaccine, and mRNA vaccine were 0.0075, 0.0110, 0.0208, and 0.0249 QALYs and saved costs of US$163.96, US$261.73, US$583.21, and US$724.49, respectively. Under the Omicron virus pandemic, the sequential vaccination among adults and the elderly (aged 60-69, 70-79, over 80) was consistently cost-saving, and a booster shot of the mRNA vaccine was more cost-saving. The results indicate that the sequential vaccination strategy is cost-effective in addressing the COVID-19 pandemic, and improving vaccination coverage among the elderly is of great importance in avoiding severe cases and deaths.

Disability-adjusted life years (DALYs) based COVID-19 health impact assessment: A systematic review protocol

Background

COVID-19 is a highly contagious infectious disease that emerged in 2019. This disease is causing devastating health, socio-economic, and economic crises. More specifically COVID-19 is affecting both the quality and length of human life. The overall health impact of this disease is measured by the disability-adjusted life years which is the sum of the life years lost due to disability (the effect on the health quality) and the years life lost due to premature death (effect on the length of life). The purpose of this review is to summarise DALYs-based health impact publications and produce compiled and informative literature that can aid the health regulators to make evidence-based decisions on mitigating COVID-19.

Methods

The review will be conducted using the PRISMA 2020 guidelines. The DALYs-based original observational and cross-sectional studies will be collected for assessing the health impact of COVID-19. Both the life quality and length impacts of COVID-19 will be reviewed. The life quality impact of COVID-19 will be measured using the life years lost due to disability (pre-recovery illness, pre-death illness, and post-acute consequences), and its impact on the length of life will be measured with years of life lost due to premature death (shortening of life expectancy). The combined health impact of COVID-19 on the quality and length of life will be measured in disability-adjusted life years.

Discussion

The impacts of COVID-19 on the two health outcomes (quality and length of life) will indicate the level of COVID-19 health burden. The increase or decrease of COVID-19 health impact might be due to the sample size differences of different studies and the omission of years lost due to post-acute consequences in some studies. After having a summarized systematic review health decision-makers will apply an impact-based response to COVID-19.

Trail registration

Systematic review registration: This protocol is pre-registered in PROSPERO with the registration number CRD42022324931.

Optimal subsidy policies of the Chinese cruise market under the impact of COVID-19

The spread of the COVID-19 pandemic has caused severe damage to the Chinese cruise market since 2020. It is crucial for the local government to reformulate the subsidy policy to respond to the changing environment. We propose a cruise supply chain system to investigate the choice of subsidy recipients and the setting of optimal subsidy levels with a budget-constrained government during the access restriction period and post-epidemic period. We find that in both periods, as long as the subsidy achieves the optimal level, either the cruise lines, the travel agency, or the passengers as recipients of the subsidy policy can maximize the market demand and recover the cruise market after the COVID-19 outbreak. However, as the budget increases, subsidizing passengers can improve the "low price dilemma" of the Chinese cruise market. Compared with the access restriction period, the local government should adjust the subsidy level in the post-epidemic period. Interestingly, the subsidy policy does not always positively impact the international cruise line's profit in the post-epidemic period.

Evaluating Effects of Dynamic Interventions to Control COVID-19 Pandemic: A Case Study of Guangdong, China

The emergence of different virus variants, the rapidly changing epidemic, and demands for economic recovery all require continual adjustment and optimization of COVID-19 intervention policies. For the purpose, it is both important and necessary to evaluate the effectiveness of different policies already in-place, which is the basis for optimization. Although some scholars have used epidemiological models, such as susceptible-exposed-infected-removed (SEIR), to perform evaluation, they might be inaccurate because those models often ignore the time-varying nature of transmission rate. This study proposes a new scheme to evaluate the efficiency of dynamic COVID-19 interventions using a new model named as iLSEIR-DRAM. First, we improved the traditional LSEIR model by adopting a five-parameter logistic function β(t) to depict the key parameter of transmission rate. Then, we estimated the parameters by using an adaptive Markov Chain Monte Carlo (MCMC) algorithm, which combines delayed rejection and adaptive metropolis samplers (DRAM). Finally, we developed a new quantitative indicator to evaluate the efficiency of COVID-19 interventions, which is based on parameters in β(t) and considers both the decreasing degree of the transmission rate and the emerging time of the epidemic inflection point. This scheme was applied to seven cities in Guangdong Province. We found that the iLSEIR-DRAM model can retrace the COVID-19 transmission quite well, with the simulation accuracy being over 95% in all cities. The proposed indicator succeeds in evaluating the historical intervention efficiency and makes the efficiency comparable among different cities. The comparison results showed that the intervention policies implemented in Guangzhou is the most efficient, which is consistent with public awareness. The proposed scheme for efficiency evaluation in this study is easy to implement and may promote precise prevention and control of the COVID-19 epidemic.

Effectiveness and Cost-Effectiveness of Inactivated Vaccine to Address COVID-19 Pandemic in China: Evidence From Randomized Control Trials and Real-World Studies

Objective

This study aimed to determine the efficacy, effectiveness, and cost-effectiveness of inactivated COVID-19 vaccines (CoronaVac and BBIBP-CorV) in China using existing international clinical trials and real-world evidence.

Methods

Through a search of PubMed, Embase, Web of Science, and CNKI, studies investigating the effectiveness of inactivated COVID-19 vaccines were identified, and a meta-analysis was undertaken to synthesize the vaccine efficacy and effectiveness data. Moreover, a decision-analytic model was developed to estimate the cost-effectiveness of inactivated vaccines for combating the COVID-19 pandemic in the Chinese context from a societal perspective. Results of the meta-analysis, along with cost data from official websites and works of literature were used to populate the model. Sensitivity analysis was performed to test the robustness of the model results.

Results

A total of 24 studies were included in the meta-analysis. In comparison to no immunization, the effectiveness of inactivated vaccine against COVID-19 infection, hospitalization, ICU admission and death were 65.18% (95% CI 62.62, 67.75), 79.10% (95% CI 71.69, 86.51), 90.46% (95% CI 89.42, 91.50), and 86.69% (95% CI 85.68, 87.70); and the efficacy against COVID-19 infection and hospitalization were 70.56% (95% CI 57.87, 83.24) and 100% (95% CI 61.72, 100). Inactivated vaccine vaccination prevented more infections, hospitalizations, ICU admissions, and deaths with lower total costs, thus was cost-saving from a societal perspective in China. Base-case analysis results were robust in the one-way sensitivity analysis, and the percentage of ICU admission or death and direct medical cost ranked the top influential factors in our models. In the probabilistic sensitivity analysis, vaccination had a 100% probability of being cost-effective.

Conclusion

Inactivated vaccine is effective in preventing COVID-19 infection, hospitalization, ICU admission and avoiding COVID-19 related death, and COVID-19 vaccination program is cost-saving from societal perspective in China.

Economic evaluations of interventions against viral pandemics: a scoping review

OBJECTIVES

The COVID-19 pandemic has led to suggestions that cost-effectiveness analyses should adopt a broader perspective when estimating costs. This review aims to provide an overview of economic evaluations of interventions against viral pandemics in terms of the perspective taken, types of costs included, comparators, type of economic model, data sources and methods for estimating productivity costs.

STUDY DESIGN

Scoping literature review.

METHODS

Publications were eligible if they conducted a cost-effectiveness analysis, cost-utility analysis, cost-benefit analysis or cost-minimisation analysis and evaluated interventions aimed at viral pandemics or for patients infected with viral pandemic disease. We searched PubMed, Embase and Scopus for relevant references and charted data from the selected full-text publications into a predefined spreadsheet based on research sub-questions, summary tables and figures.

RESULTS

From 5410 references, 36 full-text publications fulfilled the inclusion criteria. The economic evaluations were mainly model based and included direct medical costs of hospital treatment. Around half of the studies included productivity costs and the proportion of total costs attributed to productivity costs ranged from 10% to 90%, depending on estimation methods, assumptions about valuation of time, type of intervention, severity of illness and degree of transmission.

CONCLUSIONS

Economic evaluations of interventions against viral pandemics differed in terms of estimation methods and reporting of productivity costs, even for similar interventions. Hence, the literature on economic evaluations for pandemic response would benefit from having standards for conducting and reporting economic evaluations, especially for productivity costs.

A Data-Driven Analysis of the Economic Cost of Non-Pharmaceutical Interventions: A Cross-Country Comparison of Kenya, Singapore, and Thailand

Objective: To estimate the economic impact of border closure and social distancing by estimating the decline of gross domestic product (GDP) in Kenya, Singapore and Thailand.

Methods: We analysed secondary data retrospectively. To calculate impact of NPIs on GDP, the relationship between GDP and stock market index was examined using ordinary least squares (OLS). Then, autoregressive and moving averages (ARMA) model was used to examine the impact of NPI on stock market index. The change in GDP due to NPIs was derived by multiplying coefficients of OLS and ARMA models.

Results: An increase in stock market index correlated with an increase in GDP, while both social distancing and border closure negatively correlated with stock market index. Implementation of NPIs correlated with the decline in GDP. Thai border closure had a greater decline in GDP than social distancing; Kenya exhibited the same trends; Singapore had the opposite trend.

Conclusion: We quantified the magnitude of economic impact of NPIs in terms of GDP decline by linking stock market index and GDP. This approach may be applicable in other settings.

Cost-effectiveness of interventions for the prevention and control of COVID-19: Systematic review of 85 modelling studies

Background

We aimed to quantitatively summarise the health economic evaluation evidence of prevention and control programs addressing COVID-19 globally.

Methods

We did a systematic review and meta-analysis to assess the economic and health benefit of interventions for COVID-19. We searched PubMed, Embase, Web of Science, and Cochrane Library of economic evaluation from December 31, 2019, to March 22, 2022, to identify relevant literature. Meta-analyses were done using random-effects models to estimate pooled incremental net benefit (INB). Heterogeneity was assessed using I2 statistics and publication bias was assessed by Egger's test. This study is registered with PROSPERO, CRD42021267475.

Results

Of 16 860 studies identified, 85 articles were included in the systematic review, and 25 articles (10 studies about non-pharmacological interventions (NPIs), five studies about vaccinations and 10 studies about treatments) were included in the meta-analysis. The pooled INB of NPIs, vaccinations, and treatments were $1378.10 (95% CI = $1079.62, $1676.59), $254.80 (95% CI = $169.84, $339.77) and $4115.11 (95% CI = $1631.09, $6599.14), respectively. Sensitivity analyses showed similar findings.

Conclusions

NPIs, vaccinations, and treatments are all cost-effective in combating the COVID-19 pandemic. However, evidence was mostly from high-income and middle-income countries. Further studies from lower-income countries are needed.

Study of the Economic, Environmental, and Social Factors Affecting Chinese Residents' Health Based on Machine Learning

The Healthy China Strategy puts realistic demands for residents' health levels, but the reality is that various factors can affect health. In order to clarify which factors have a great impact on residents' health, based on China's provincial panel data from 2011 to 2018, this paper selects 17 characteristic variables from the three levels of economy, environment, and society and uses the XG boost algorithm and Random forest algorithm based on recursive feature elimination to determine the influencing variables. The results show that at the economic level, the number of industrial enterprises above designated size, industrial added value, population density, and per capita GDP have a greater impact on the health of residents. At the environmental level, coal consumption, energy consumption, total wastewater discharge, and solid waste discharge have a greater impact on the health level of residents. Therefore, the Chinese government should formulate targeted measures at both economic and environmental levels, which is of great significance to realizing the Healthy China strategy.

Assessment of Dietary and Lifestyle Responses After COVID-19 Vaccine Availability in Selected Arab Countries

Background

The COVID-19 pandemic has been consistently associated with unhealthy lifestyle behaviors and dietary practices. This study aimed to assess the dietary and lifestyle behaviors of adults after COVID-19 vaccine availability and their attitude toward the vaccine in selected Arab countries.

Methods

A cross-sectional survey-based study was conducted between October 2021 and December 2021 using Google Forms (n = 2259). A multi-component questionnaire was used to collect socio-demographic characteristics, attitudes toward the COVID-19 vaccine, and behavioral, dietary, and lifestyle responses after easing the restriction. Participants were given a score based on the sum of positive dietary and lifestyle changes. The generalized linear models were used to identify the association between positive dietary and lifestyle changes score and sociodemographic characteristics.

Results

Weight gain during the pandemic was reported by 39.5% of the participants, 36.1% reported ever getting infected with the COVID-19 virus, and 85% received at least one dose of the vaccine. The key adverse reactions of the COVID-19 vaccine were fatigue, headache, and joint pain, and the main reason for vaccination was protection against infection. Most participants were concerned about the vaccine side effects (45.8%) and inadequate testing (50.7%). After easing of restriction, 54.3% of the participants reduced the frequency of disinfecting objects, and 58.3% joined social events. Most dietary and lifestyle behaviors remained unchanged after vaccine availability but there was an increase in the time spent behind the screen for work (50.1%) and entertainment (42.9%). The results of the multivariate regression analyses revealed that older participants (p = 0.001), those with higher education (p = 0.010), and those working from home (p = 0.040) were more likely to have higher positive dietary and lifestyle changes scores.

Conclusion

Although most participants were concerned about vaccine safety, low vaccine hesitancy rates were observed among the study sample. The availability of the COVID-19 vaccines resulted in loosening some of the safety social measures among Arab adults but the negative impact of the pandemic on dietary and lifestyle behaviors remained unaltered.

COVID-19 Induced Economic Slowdown and Mental Health Issues

The COVID-19 pandemic has pressed a pause button on global economic development, and induced significant mental health problems. In order to demonstrate the progressed relationship between the pandemic, economic slowdown, and mental health burden, we overviewed the global-level gross domestic product changes and mental problems variation since the outbreak of COVID-19, and reviewed comprehensively the specific sectors influenced by the pandemic, including international trade, worldwide travel, education system, healthcare system, and individual employment. We hope to provide timely evidence to help with the promotion of policymakers’ effective strategies in mitigating economic losses induced by the pandemic; we suggest different governments or policy makers in different countries to share information and experience in dealing with COVID-19-induced economic slowdown and promote COVID-19 vaccine popularization plan to protect every individual worldwide against the coronavirus essentially; and we appeal international information share and collaboration to minimize stigmatization related to adverse mental consequences of COVID-19 and to increase mental health wellbeings of people all over the world.

Disability-adjusted life years (DALYs) due to the direct health impact of COVID-19 in India, 2020

COVID-19 has affected all countries. Its containment represents a unique challenge for India due to a large population (> 1.38 billion) across a wide range of population densities. Assessment of the COVID-19 disease burden is required to put the disease impact into context and support future pandemic policy development. Here, we present the national-level burden of COVID-19 in India in 2020 that accounts for differences across urban and rural regions and across age groups. Input data were collected from official records or published literature. The proportion of excess COVID-19 deaths was estimated using the Institute for Health Metrics and Evaluation, Washington data. Disability-adjusted life years (DALY) due to COVID-19 were estimated in the Indian population in 2020, comprised of years of life lost (YLL) and years lived with disability (YLD). YLL was estimated by multiplying the number of deaths due to COVID-19 by the residual standard life expectancy at the age of death due to the disease. YLD was calculated as a product of the number of incident cases of COVID-19, disease duration and disability weight. Scenario analyses were conducted to account for excess deaths not recorded in the official data and for reported COVID-19 deaths. The direct impact of COVID-19 in 2020 in India was responsible for 14,100,422 (95% uncertainty interval [UI] 14,030,129–14,213,231) DALYs, consisting of 99.2% (95% UI 98.47–99.64%) YLLs and 0.80% (95% UI 0.36–1.53) YLDs. DALYs were higher in urban (56%; 95% UI 56–57%) than rural areas (44%; 95% UI 43.4–43.6) and in men (64%) than women (36%). In absolute terms, the highest DALYs occurred in the 51–60-year-old age group (28%) but the highest DALYs per 100,000 persons were estimated for the 71–80 years old age group (5481; 95% UI 5464–5500 years). There were 4,815,908 (95% UI 4,760,908–4,924,307) DALYs after considering reported COVID-19 deaths only. The DALY estimations have direct and immediate implications not only for public policy in India, but also internationally given that India represents one sixth of the world’s population.

Estimating US Earnings Loss Associated with COVID-19 Based on Human Capital Calculation

Infection with COVID-19 could result in lockdown, quarantine of contacts, absenteeism from work, and temporary productivity loss. This research aims to calculate (1) how the pandemic affects on-the-job probability and earnings for the working population, and (2) how much productivity loss is associated with self or a family member sick with COVID-19. Based on data collected from the U.S Research and Development Survey (RANDS), this research projects the relationship between on-the-job possibility and age of the index group and calculates the employment possibilities of the index group relative to the healthy group, namely the employment ratio. The weekly loss of productivity, presented by earnings, associated with COVID-19 for groups aged 18-44 years and 45-64 years was calculated, since the 18- to 64-year-old population is an economy's active workforce. Analytical results indicate that the older the age group, the lower the on-the-job possibility, and the higher the weekly productivity loss due to self or a family member being sick from COVID-19. For the group aged 45-64 years, the employment ratio of the index group relative to the healthy group dropped from 0.863 to 0.39, corresponding to a weekly productivity loss of 136-590 US dollars. The overall impact would be about a 9% loss in GDP. Infected or quarantined people would be confined to working in relatively isolated offices or places to allow for social distancing. Proactive health promotion in the workplace plus reactive work through telecommunication systems would reduce such losses. Such preparedness needs to be implemented early for more vulnerable workers who are of middle or old age and/or those comorbid with diabetes.

The economic impacts of traffic consumption during the COVID-19 pandemic in China: A CGE analysis

The transportation sector has played an important role during the COVID-19 pandemic. Like many industries, it experienced a sharp decline during the pandemic. The reduced traffic consumption has been caused by objective conditions, such as traffic control measures, and subjective factors, such as the perception of the COVID-19 pandemic. This study uses the computable general equilibrium (CGE) model to examine the economic impacts of traffic consumption during the COVID-19 pandemic in China. Moreover, to evaluate the impact of the government's economic stimulus policy related to transportation, this study examines the policy effects of transportation investment. This study suggests that, first, China's macroeconomy has been severely affected by reduced traffic consumption. The period when the pandemic was most severe had the largest GDP decrease (0.49%). Second, transportation consumption is closely associated with the output of all industries. As the pandemic worsens, the output of all sectors declines more. Of the transport sectors, road transport has the largest output decrease (10.17%), followed by railway (1.76%) and air sectors (1.53%). The service industry is the most negatively affected among the non-transportation sectors. Finally, transportation infrastructure investment can effectively promote the economy and create jobs. In addition, railway investment plays a more positive role in the economy than road and air transports. The findings provide a detailed understanding of the economic impact of the significantly reduced traffic consumption at different stages of the pandemic.

The Power of Music to Prevent and Control Emerging Infectious Diseases

Music is a powerful approach to engage communities and disseminate information. Specifically, health campaigns employing music have been used to promote behaviors that can prevent emerging infectious diseases (EIDs). For example, hip hop artists supported campaigns to prevent acquired immunodeficiency syndrome in the 70s in the United States, while Brazilian funk promoted vaccination to mitigate the ongoing COVID-19 pandemic. Similarly, we broadcast musical messages in local languages to increase community awareness and support prevention measures in Guinea and Liberia in response to the recent Ebola outbreak in 2021. Given the potential of music to promote both individual and population-level behavioral changes to prevent transmission, there is a need to consolidate information on music-based health interventions, and on how we can measure their effectiveness. In this perspective, we provide examples of relevant initiatives, discussing challenges and solutions associated with implementing interventions based on our experience with the 2021 Ebola outbreak. We recommend four steps for a successful music-based health intervention including (1) establishing a task force, (2) compose a "catchy" song including critical preventive measures, (3) deliver the song to the target audience, and (4) evaluate the campaign effectiveness. We argue that close interactions between scientists and musicians can produce rapid musical content for disease prevention. We also identify and discuss several methodological frameworks for testing the effectiveness of such interventions. We conclude that support from public health authorities, government media departments, and international agencies, is necessary to deliver wide outreach and long-term sustainability of musical messaging toward effective EID prevention.

Cost-Effectiveness of COVID-19 Policy Measures: A Systematic Review

OBJECTIVES

The COVID-19 pandemic has had a major impact on our society, with drastic policy restrictions being implemented to contain the spread of the severe acute respiratory syndrome coronavirus 2. This study aimed to provide an overview of the available evidence on the cost-effectiveness of various coronavirus disease 2019 policy measures.

METHODS

A systematic literature search was conducted in PubMed, Embase, and Web of Science. Health economic evaluations considering both costs and outcomes were included. Their quality was comprehensively assessed using the Consensus Health Economic Criteria checklist. Next, the quality of the epidemiological models was evaluated.

RESULTS

A total of 3688 articles were identified (March 2021), of which 23 were included. The studies were heterogeneous with regard to methodological quality, contextual factors, strategies' content, adopted perspective, applied models, and outcomes used. Overall, testing/screening, social distancing, personal protective equipment, quarantine/isolation, and hygienic measures were found to be cost-effective. Furthermore, the most optimal choice and combination of strategies depended on the reproduction number and context. With a rising reproduction number, extending the testing strategy and early implementation of combined multiple restriction measures are most efficient.

CONCLUSIONS

The quality assessment highlighted numerous flaws and limitations in the study approaches; hence, their results should be interpreted with caution because the specific context (country, target group, etc) is a key driver for cost-effectiveness. Finally, including a societal perspective in future evaluations is key because this pandemic has an indirect impact on the onset and treatment of other conditions and on our global economy.

Community-Based Monitoring in the New Normal: A Strategy for Tackling the COVID-19 Pandemic in Malaysia

In 2020, the COVID-19 pandemic severely impacted the global public health system and led to many deaths worldwide. COVID-19 is highly contagious and can be spread by symptomatic or asymptomatic individuals. As such, determining the risk of infection within a community is difficult. To mitigate the risk of the spread of COVID-19, the government of Malaysia implemented seven phases of the movement control order (MCO) from 18 March to 31 December 2020. However, the socioeconomic cost was substantial despite the effectiveness of the MCO in bringing down cases of infection. As noted by the Prime Minister of Malaysia, the final criterion that should be met is community empowerment. In other words, community-based mitigation measures through which communities unite to contain the pandemic are essential before the completion of the vaccination program. As a measure for controlling the pandemic, mitigation strategies in the new normal should be feasible, practical, and acceptable to communities. In this paper, we present a deliberation of a set of community-based monitoring criteria to ensure health and well-being in communities, such as efficacy, technicality, feedback, and sustainability. The proposed criteria will be instrumental in developing community-based monitoring initiatives to achieve the desired goals in coping with the pandemic as well as in empowering communities to be part of the governance process.

Despite vaccination, China needs non-pharmaceutical interventions to prevent widespread outbreaks of COVID-19 in 2021

COVID-19 vaccination is being conducted in over 200 countries and regions to control SARS-CoV-2 transmission and return to a pre-pandemic lifestyle. However, understanding when non-pharmaceutical interventions (NPIs) can be lifted as immunity builds up remains a key question for policy makers. To address this, we built a data-driven model of SARS-CoV-2 transmission for China. We estimated that, to prevent the escalation of local outbreaks to widespread epidemics, stringent NPIs need to remain in place at least one year after the start of vaccination. Should NPIs alone be capable of keeping the reproduction number (R_t) around 1.3, the synergetic effect of NPIs and vaccination could reduce the COVID-19 burden by up to 99% and bring R_t below the epidemic threshold in about 9 months. Maintaining strict NPIs throughout 2021 is of paramount importance to reduce COVID-19 burden while vaccines are distributed to the population, especially in large populations with little natural immunity.

Using data-driven epidemiological modelling, Yu et al. estimate that, even with increasing vaccine availability, China will have to maintain stringent non-pharmaceutical interventions for at least a year to prevent new widespread outbreaks of COVID-19.