Examining the cost-effectiveness of personal protective equipment for formal healthcare workers in Kenya during the COVID-19 pandemic

The effectiveness of combined approaches towards improving utilisation of adolescent sexual and reproductive health services in Kenya: a quasi-experimental evaluation

Adolescent sexual and reproductive health (ASRH) services are key to improving the health of adolescents. This study aimed to establish the effectiveness of an intervention that combined activities in health facilities and communities in Kenya to increase utilisation of ASRH services. A quasi-experimental evaluation design was used to assess the effectiveness of the intervention. Using a stratified cluster sampling approach, two cross-sectional household surveys targeting girls aged 15-19 were conducted at baseline (September 2019) and endline (December 2020) in intervention and comparison. We combined the difference-in-difference approach to analyse the net change in outcomes between intervention and comparison arms of the study at baseline and endline and coarsened exact matching for variables that were significantly different to address the imbalance. There were a total of 1011 participants in the intervention arm and 880 in the comparison arm. Descriptive results showed a net increase of 12.7% in intervention sites in the knowledge of misconceptions about sex, pregnancy, and contraception, compared to 10.4% in the control site. In the multivariate regression analysis, two outcomes remained significant: decreases in adolescents' discomfort when seeking ASRH services because of either fear of parents (aPR = 0.58, 95% CI = 0.42-0.79, P = 0.001) or a lack of support from their partner (aPR = 0.25, 95% CI = 0.08-0.82, P = 0.023). The intervention combining a facility and community approach was not effective in increasing the use of ASRH information and services. Possible reasons for this are explored.

The Cost We Bear: Financial Implications for Hip Fracture Care Amidst the COVID-19 Pandemic

INTRODUCTION

The purpose of this study was to assess the impact of COVID-19 on the cost of hip fracture care in the geriatric/middle-aged cohort, hypothesizing the cost of care increased during the pandemic, especially in COVID+ patients.

METHODS

Between October 2014 and January 2022, 2,526 hip fracture patients older than 55 years were analyzed for demographics, injury details, COVID status on admission, hospital quality measures, and inpatient healthcare costs from the inpatient admission. Comparative analyses were conducted between: (1) All comers and high-risk patients in the prepandemic (October 2014 to January 2020) and pandemic (February 2020 to January 2022) cohorts and (2) COVID+ and COVID- patients during the pandemic. Subanalysis assessed the difference in cost breakdown for patients in the overall cohorts, the high-risk quartiles, and between the prevaccine and postvaccine pandemic cohorts.

RESULTS

Although the total costs of admission for all patients, and specifically high-risk patients, were not notably higher during the pandemic, further breakdown showed higher costs for the emergency department, laboratory/pathology, radiology, and allied health services during the pandemic, which was offset by lower procedural costs. High-risk COVID+ patients had higher total costs than high-risk COVID- patients ( P < 0.001), most notably in room-and-board ( P = 0.032) and allied health ( P = 0.023) costs. Once the pandemic started, subgroup analysis demonstrated no change in the total cost in the prevaccine and postvaccine cohort.

CONCLUSION

The overall inpatient cost of hip fracture care did not increase during the pandemic. Although individual subdivisions of cost signified increased resource utilization during the pandemic, this was offset by lower procedural costs. COVID+ patients, however, had notably higher total costs compared with COVID- patients driven primarily by increased room-and-board costs. The overall cost of care for high-risk patients did not decrease after the widespread administration of the COVID-19 vaccine.

LEVEL OF EVIDENCE

III.

Availability and use of personal protective equipment in low- and middle-income countries during the COVID-19 pandemic

BACKGROUND

Availability and appropriate use of personal protective equipment (PPE) is of particular importance in Low and Middle-Income countries (LMICs) where disease outbreaks other than COVID-19 are frequent and health workers are scarce. This study assesses the availability of necessary PPE items during the COVID-19 pandemic at health facilities in seven LMICs.

METHODS

Data were collected using a rapid-cycle survey among 1554 health facilities in seven LMICs via phone-based surveys between August 2020 and December 2021. We gathered data on the availability of World Health Organization (WHO)-recommended PPE items and the use of items when examining patients suspected to be infected with COVID-19. We further investigated the implementation of service adaptation measures in a severe shortage of PPE.

RESULTS

There were major deficiencies in PPE availability at health facilities. Almost 3 out of 10 health facilities reported a stock-out of medical masks on the survey day. Forty-six percent of facilities did not have respirator masks, and 16% did not have any gloves. We show that only 43% of health facilities had sufficient PPE to comply with WHO guidelines. Even when all items were available, healthcare workers treating COVID-19 suspected patients were reported to wear all the recommended equipment in only 61% of health facilities. We did not find a statistically significant difference in implementing service adaptation measures between facilities experiencing a severe shortage or not.

CONCLUSION

After more than a year into the COVID-19 pandemic, the overall availability of PPE remained low in our sample of low and middle-income countries. Although essential, the availability of PPE did not guarantee the proper use of the equipment. The lack of PPE availability and improper use of available PPE enable preventable COVID-19 transmission in health facilities, leading to greater morbidity and mortality and risking the continuity of service delivery by healthcare workers.

Cost-benefit analysis of partnership working between fire and rescue and health services across England and Wales during the COVID-19 pandemic

OBJECTIVES

Fire and rescue services undertook a range of additional activities to support the National Health Service (NHS) in managing extreme service demand during the COVID-19 pandemic. This study aims to examine the cost-benefit of partnership work between fire and rescue services and the NHS during the COVID-19 pandemic.

SETTING

England and Wales.

DESIGN

A cost-benefit approach was used. Data relating to resources and outcomes was accessed from a National Data Portal commissioned by the National Fire Chiefs Council to record fire and rescue service responses throughout the pandemic. Literature-based economic estimates were applied to establish the potential cost-benefit of fire and rescue services undertaking support activities.

RESULTS

Fire and rescue services commonly undertook eight activities to support ambulance services and hospitals in three key areas: (1) driving ambulances, (2) provision of personal protective equipment for healthcare workers and (3) mass testing and mass vaccination. Benefits outweighed costs for all activities. Total costs were estimated at £93.26 million and total benefits were between £171.46 million and £1.10 billion.

CONCLUSIONS

This is the first economic evaluation of partnership working between fire and rescue and health services during a pandemic. Findings highlight the social and economic value of co-operation between fire and rescue services and the NHS and provides important evidence for informing public sector decisions regarding the allocation of resources in future public health crises.

The economic value of personal protective equipment for healthcare workers

In this paper, we examine the cost effectiveness of investment in personal protective equipment (PPE) for protecting health care workers (HCWs) against two infectious diseases: Ebola virus and methicillin-resistant Staphylococcus aureus (MRSA). This builds on similar work published for COVID-19 in 2020. We developed two separate decision-analytic models using a payer perspective to compare the costs and effects of multiple PPE use scenarios for protection of HCW against Ebola and MRSA. Bayesian multivariate sensitivity analyses were used to consider the uncertainty surrounding all key parameters for both diseases. We estimate the cost to provide adequate PPE for a HCW encounter with an Ebola patient is $13.04, which is associated with a 97% risk reduction in infections. The mean incremental cost-effectiveness ratio (ICER) is $3.98 per disability-adjusted life year (DALY) averted. Because of lowered infection and disability rates, this investment is estimated to save $132.27 in averted health systems costs, a financial ROI of 1,014%. For MRSA, the cost of adequate PPE for one HCW encounter is $0.88, which is associated with a 53% risk reduction in infections. The mean ICER is $362.14 per DALY averted. This investment is estimated to save $20.18 in averted health systems costs, a financial ROI of 2,294%. In terms of total health savings per death averted, investing in adequate PPE is the dominant strategy for Ebola and MRSA, suggesting that it is both more costly and less clinically optimal to not fully invest in PPE for these diseases. There are many compelling reasons to invest in PPE to protect HCWs. This analysis examines the economic case, building on previous evidence that protecting HCWs with PPE is cost-effective for COVD-19. Ebola and MRSA scenarios were selected to allow assessment of both endemic and epidemic infectious diseases. While PPE is cost-effective for both conditions, compared to our analysis for COVID-19, PPE is relatively more cost-effective for Ebola and relatively less so for MRSA. Further research is needed to assess shortfalls in the PPE supply chain identified during the COVID-19 pandemic to ensure an efficient and resilient supply in the face of future pandemics.

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.

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.

Interventions to Mitigate COVID-19 Misinformation: A Systematic Review and Meta-Analysis

The duration and impact of the COVID-19 pandemic depends largely on individual and societal actions which are influenced by the quality and salience of the information to which they are exposed. Unfortunately, COVID-19 misinformation has proliferated. Despite growing attempts to mitigate COVID-19 misinformation, there is still uncertainty regarding the best way to ameliorate the impact of COVID-19 misinformation. To address this gap, the current study uses a meta-analysis to evaluate the relative impact of interventions designed to mitigate COVID-19-related misinformation. We searched multiple databases and gray literature from January 2020 to September 2021. The primary outcome was COVID-19 misinformation belief. We examined study quality and meta-analysis was used to pool data with similar interventions and outcomes. 16 studies were analyzed in the meta-analysis, including data from 33378 individuals. The mean effect size of interventions to mitigate COVID-19 misinformation was positive, but not statistically significant [d = 2.018, 95% CI (-0.14, 4.18), p = .065, k = 16]. We found evidence of publication bias. Interventions were more effective in cases where participants were involved with the topic, and where text-only mitigation was used. The limited focus on non-U.S. studies and marginalized populations is concerning given the greater COVID-19 mortality burden on vulnerable communities globally. The findings of this meta-analysis describe the current state of the literature and prescribe specific recommendations to better address the proliferation of COVID-19 misinformation, providing insights helpful to mitigating pandemic outcomes.