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Chimukuche RS, Kawuma R, Nkosi B, Seeley J. Scoping review on lessons learnt on the promotion and use of drugs and traditional medicine in Africa during COVID-19. Glob Public Health 2024; 19:2323028. [PMID: 38471036 DOI: 10.1080/17441692.2024.2323028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/20/2024] [Indexed: 03/14/2024]
Abstract
ABSTRACTScientific evidence on the safety and efficacy of pharmaceutical drugs, substances and herbal medicines is important in medical advertising and promotion. Following guidelines for conducting a scoping review, we systematically searched PubMed, SCOPUS and Web of Science to identify in peer reviewed articles medications that were promoted and used widely in Africa during the COVID-19 pandemic. We also searched for information about how safety concerns about untested/or not properly tested drugs were communicated to the public during the pandemic. Of the 2043 articles identified, 41 papers were eligible for inclusion. Most studies were clinical trials (n = 11), systematic reviews (n = 9), quantitative studies (n = 9) the rest were qualitative studies, reviews and reports. We found that following global trends, several drugs, traditional and herbal treatments were used and repurposed for the treatment of respiratory symptoms of COVID-19 in Africa. The results highlighted the value of some herbal medicines for treatment during the COVID-19 pandemic, as well as the risks posed by the unregulated sharing of advice and recommendations on treatments in Africa, and globally.
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Affiliation(s)
- Rujeko Samanthia Chimukuche
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infection & Immunity, University College London, London, UK
| | - Rachel Kawuma
- Social Science, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Busisiwe Nkosi
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Law, University of KwaZulu-Natal, Durban, South Africa
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Social Science, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- School of Public Health and Nursing, University of KwaZulu-Natal, Durban, South Africa
- Department of Global Health and Development, London School of Tropical Hygiene and Medicine, London, UK
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Trejo I, Hung PY, Matrajt L. Covid19Vaxplorer: a free, online, user-friendly COVID-19 Vaccine Allocation Comparison Tool. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.15.23291472. [PMID: 37986918 PMCID: PMC10659519 DOI: 10.1101/2023.06.15.23291472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Background There are many COVID-19 vaccines currently available, however, Low- and middle-income countries (LMIC) still have large proportions of their populations unvaccinated. Decision-makers must decide how to effectively allocate available vaccines (e.g. boosters or primary series vaccination, which age groups to target) but LMIC often lack the resources to undergo quantitative analyses of vaccine allocation, resulting in ad-hoc policies. We developed Covid19Vaxplorer (https://covid19vaxplorer.fredhutch.org/), a free, user-friendly online tool that simulates region-specific COVID-19 epidemics in conjunction with vaccination with the purpose of providing public health officials worldwide with a tool for vaccine allocation planning and comparison. Methods We developed an age-structured mathematical model of SARS-CoV-2 transmission and COVID-19 vaccination. The model considers vaccination with up to three different vaccine products, primary series and boosters. We simulated partial immunity derived from waning of natural infection and vaccination. The model is embedded in an online tool, Covid19Vaxplorer that was optimized for its ease of use. By prompting users to fill information through several windows to input local parameters (e.g. cumulative and current prevalence), epidemiological parameters (e.g basic reproduction number, current social distancing interventions), vaccine parameters (e.g. vaccine efficacy, duration of immunity) and vaccine allocation (both by age groups and by vaccination status). Covid19Vaxplorer connects the user to the mathematical model and simulates, in real time, region-specific epidemics. The tool then produces key outcomes including expected numbers of deaths, hospitalizations and cases, with the possibility of simulating several scenarios of vaccine allocation at once for a side-by-side comparison. Results We provide two usage examples of Covid19Vaxplorer for vaccine allocation in Haiti and Afghanistan, which had as of Spring 2023 2% and 33% of their populations vaccinated, and show that for these particular examples, using available vaccine as primary series vaccinations prevents more deaths than using them as boosters. Covid19Vaxplorer allows users in 183 regions in the world to compare several vaccination strategies simultaneously, adjusting parameters to their local epidemics, infrastructure and logistics. Covid19Vaxplorer is an online, free, user-friendly tool that facilitates evidence-based decision making for vaccine distribution.
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Affiliation(s)
- Imelda Trejo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, US
| | - Pei-Yao Hung
- Institute For Social Research, University of Michigan, Ann Arbor, MI, US
| | - Laura Matrajt
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, US
- Department of Applied Mathematics, University of Washington, Seattle, WA, US
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Matrajt L, Brown ER, Cohen MS, Dimitrov D, Janes H. Could widespread use of antiviral treatment curb the COVID-19 pandemic? A modeling study. BMC Infect Dis 2022; 22:683. [PMID: 35945513 PMCID: PMC9361252 DOI: 10.1186/s12879-022-07639-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/20/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Despite the development of safe and effective vaccines, effective treatments for COVID-19 disease are still urgently needed. Several antiviral drugs have shown to be effective in reducing progression of COVID-19 disease. METHODS In the present work, we use an agent-based mathematical model to assess the potential population impact of the use of antiviral treatments in four countries with different demographic structure and current levels of vaccination coverage: Kenya, Mexico, United States (US) and Belgium. We analyzed antiviral effects on reducing hospitalization and death, and potential antiviral effects on reducing transmission. For each country, we varied daily treatment initiation rate (DTIR) and antiviral effect in reducing transmission (AVT). RESULTS Irrespective of location and AVT, widespread antiviral treatment of symptomatic adult infections (20% DTIR) prevented the majority of COVID-19 deaths, and recruiting 6% of all adult symptomatic infections daily reduced mortality by over 20% in all countries. Furthermore, our model projected that targeting antiviral treatment to the oldest age group (65 years old and older, DTIR of 20%) can prevent over 30% of deaths. Our results suggest that early antiviral treatment (as soon as possible after inception of infection) is needed to mitigate transmission, preventing 50% more infections compared to late treatment (started 3 to 5 days after symptoms onset). Our results highlight the synergistic effect of vaccination and antiviral treatment: as the vaccination rate increases, antivirals have a larger relative impact on population transmission. Finally, our model projects that even in highly vaccinated populations, adding antiviral treatment can be extremely helpful to mitigate COVID-19 deaths. CONCLUSIONS These results suggest that antiviral treatments can become a strategic tool that, in combination with vaccination, can significantly reduce COVID-19 hospitalizations and deaths and can help control SARS-CoV-2 transmission.
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Affiliation(s)
- Laura Matrajt
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, USA
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Elizabeth R. Brown
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, USA
- Department of Biostatistics, University of Washington, Seattle, USA
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Myron S. Cohen
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, USA
- Department of Biostatistics, University of Washington, Seattle, USA
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Dobromir Dimitrov
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, USA
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Department of Applied Mathematics, University of Washington, Seattle, USA
| | - Holly Janes
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, USA
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
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Ruggeri M, Signorini A, Caravaggio S, Alraddadi B, Alali A, Jarrett J, Kozma S, Harfouche C, Al Musawi T. Modeling the Potential Impact of Remdesivir Treatment for Hospitalized Patients with COVID-19 in Saudi Arabia on Healthcare Resource Use and Direct Hospital Costs: A Hypothetical Study. Clin Drug Investig 2022; 42:669-678. [PMID: 35838880 PMCID: PMC9284952 DOI: 10.1007/s40261-022-01177-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/30/2022]
Abstract
Background and Objectives Coronavirus disease 2019 (COVID-19) has spread rapidly worldwide. Saudi Arabia was significantly impacted by COVID-19. In March 2021, 381,000 cases were reported with 6539 deaths. This study attempts to quantify the impact of remdesivir on healthcare costs in Saudi Arabia, in terms of intensive care unit admissions, mechanical ventilation, and death prevention. Methods A forecasting model was designed to estimate the impact of remdesivir on the capacity of intensive care units and healthcare costs with patients requiring low flow oxygen therapy. The forecasting model was applied in the Saudi context with a 20-week projection between 1 February and 14 June, 2021. Model inputs were collected from published global and Saudi literature, available forecasting resources, and expert opinions. Three scenarios were assumed: the effective pandemic infection rate (Rt) remains at 1, the Rt increases up to 1.2, and the Rt declines from 1 to 0.8 over the study period. Results The model estimated that the use of remdesivir in hospitalized patients, in the optimistic and pessimistic scenarios, could prevent between 1520 and 3549 patient transfers to intensive care units and mechanical ventilation, prevent between 815 and 1582 deaths, and make potential cost savings between $US154 million and $US377 million owing to the reduction in intensive care unit capacity, respectively. Conclusions The treatment with remdesivir may improve patient outcomes and reduce the burden on healthcare resources during this pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s40261-022-01177-z.
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Affiliation(s)
- Matteo Ruggeri
- National Center for HTA, Istituto Superiore di Sanità, Rome, Italy. .,School of Medicine, St. Camillus International University of Health Sciences, Via della Madonnella 14 Rocca di Papa, 00040, Rome, Italy.
| | | | - Silvia Caravaggio
- School of Medicine, St. Camillus International University of Health Sciences, Via della Madonnella 14 Rocca di Papa, 00040, Rome, Italy
| | - Basem Alraddadi
- King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.,Alfaisal University, Riyadh, Saudi Arabia
| | - Alaa Alali
- Infectious Diseases Department and HIV/AIDS Centre of Excellence, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Sam Kozma
- Gilead Sciences, Dubai, United Arab Emirates
| | | | - Tariq Al Musawi
- Royal College of Surgeons in Ireland-Medical University of Bahrain (RSCI-MUB), Busaiteen, Kingdom of Bahrain.,Adult Intensive Care Unit, Dr Sulaiman AlHabib Hospital, Al-Khobar, Saudi Arabia
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Zhou L, Yan W, Li S, Yang H, Zhang X, Lu W, Liu J, Wang Y. Cost-effectiveness of interventions for the prevention and control of COVID-19: Systematic review of 85 modelling studies. J Glob Health 2022; 12:05022. [PMID: 35712857 PMCID: PMC9196831 DOI: 10.7189/jogh.12.05022] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Lihui Zhou
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Wenxin Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Shu Li
- School of Management, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Hongxi Yang
- School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Xinyu Zhang
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Wenli Lu
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Yaogang Wang
- School of Public Health, Tianjin Medical University, Tianjin, China
- Health Science and Engineering College, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Richards F, Kodjamanova P, Chen X, Li N, Atanasov P, Bennetts L, Patterson BJ, Yektashenas B, Mesa-Frias M, Tronczynski K, Buyukkaramikli N, El Khoury AC. Economic Burden of COVID-19: A Systematic Review. Clinicoecon Outcomes Res 2022; 14:293-307. [PMID: 35509962 PMCID: PMC9060810 DOI: 10.2147/ceor.s338225] [Citation(s) in RCA: 81] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/23/2022] [Indexed: 12/26/2022]
Abstract
Objective To review and qualitatively synthesize the evidence related to the economic burden of COVID-19, including healthcare resource utilization and costs. Methods A systematic review of studies that assessed the economic burden [eg, direct costs, productivity, macroeconomic impact due to non-pharmaceutical interventions (NPIs) and equity] of COVID-19 was conducted by searches in EMBASE, MEDLINE, MEDLINE-IN-PROCESS, and The Cochrane Library, as well as manual searches of unpublished research for the period between January 2020 to February 2021. Single reviewer data extraction was confirmed independently by a second reviewer. Results The screening process resulted in a total of 27 studies: 25 individual publications, and 2 systematic literature reviews, of narrower scopes, that fulfilled the inclusion criteria. The patients diagnosed with more severe COVID-19 were associated with higher costs. The main drivers for higher costs were consistent across countries and included ICU admission, in-hospital resource use such as mechanical ventilation, which lead to increase costs of $2082.65 ± 345.04 to $2990.76 ± 545.98. The most frequently reported indirect costs were due to productivity losses. On average, older COVID-19 patients incurred higher costs when compared to younger age groups. An estimation of a 20% COVID-19 infection rate based on a Monte Carlo simulation in the United States led to a total direct medical cost of $163.4 billion over the course of the pandemic. Conclusion The COVID-19 pandemic has generated a considerable economic burden on patients and the general population. Preventative measures such as NPIs only have partial success in lowering the economic costs of the pandemic. Implementing additional preventative measures such as large-scale vaccination is vital in reducing direct and indirect medical costs, decreased productivity, and GDP losses.
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Affiliation(s)
| | | | - Xue Chen
- HEMA Amaris, Shanghai, People's Republic of China
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Matrajt L, Brown ER, Cohen MS, Dimitrov D, Janes H. Could widespread use of antiviral treatment curb the COVID-19 pandemic? A modeling study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2021.11.10.21266139. [PMID: 34790985 PMCID: PMC8597888 DOI: 10.1101/2021.11.10.21266139] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Despite the development of safe and effective vaccines, effective treatments for COVID-19 disease are still desperately needed. Recently, two antiviral drugs have shown to be effective in reducing hospitalizations in clinical trials. In the present work, we use an agent-based mathematical model to assess the potential population impact of the use of antiviral treatments in four countries, corresponding to four current levels of vaccination coverage: Kenya, Mexico, United States (US) and Belgium, with 1.5, 38, 57 and 74% of their populations vaccinated. For each location, we varied antiviral coverage and antiviral effect in reducing viral load (25, 50, 75 or 100% reduction). Irrespective of location, widespread antiviral treatment of symptomatic infections (≥50% coverage) is expected to prevent the majority of COVID-19 deaths. Furthermore, even treating 20% of adult symptomatic infections, is expected to reduce mortality by a third in all countries, irrespective of the assumed treatment efficacy in reducing viral load. Our results suggest that early antiviral treatment is needed to mitigate transmission, with early treatment (within two days of symptoms) preventing 50% more infections compared to late treatment (started on days 3 to 5 after developing symptoms). Our results highlight the synergistic effect of vaccination and antiviral treatment: as vaccination rate increased, antiviral treatment had a bigger impact on overall transmission. These results suggest that antiviral treatments can become a strategic tool that, in combination with vaccination, can significantly control SASRS-CoV-2 transmission and reduce COVID-19 hospitalizations and deaths.
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Affiliation(s)
- Laura Matrajt
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Elizabeth R. Brown
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Myron S. Cohen
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dobromir Dimitrov
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Applied Mathematics, University of Washington, Seattle, WA, USA
| | - Holly Janes
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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