The economic impact of COVID-19 on healthcare systems, societies and populations

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In a recently published study review medRxiv* Preprint servers, researchers assessed the economic and medical costs incurred by the 2019 coronavirus disease (COVID-19) pandemic. They also evaluated the cost-effectiveness of surveillance, response measures and preparedness for COVID-19.

Infections with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have caused economic disruption, loss of life and social unrest with profound impacts on healthcare systems, society and the general population. Data on the economic impact of COVID-19 is essential to improve decision-making and provide resources for better preparedness for COVID-19 and future pandemics.

​​​​​​To learn: The cost of the COVID-19 pandemic versus the cost-effectiveness of mitigation strategies in EU/UK/EEA and OECD countries: a systematic review. ​​​​​​​Image credit: Corona Borealis Studio / Shutterstock

About the study

In this systematic review, researchers assessed the economic burden of COVID-19 on health systems, societies, the general population and subgroups within the population in Europe, the United Kingdom and the member states of the European Environment Agency (EEA) and the Organization for Economic Co-operation and Development (OECD).

Studies published between January 1, 2020 and April 22, 2021 in the EMBASE and Ovid Medline databases were selected to assess the costs incurred due to COVID-19 and the cost benefits of pharmaceutical and non-pharmaceutical interventions (NPIs). to determine. Public health preparedness or interventions were compared to the costs of inaction/no action and the costs of preparedness versus the costs of responding. The outcome measures of the economic assessments included the cost of each year of life gained, the cost of each quality-adjusted year of life (QALY) achieved, and the cost of cases averted by the interventions. In addition, the incremental cost-effectiveness ratio (ICER) was assessed.

The analysis first inflated costs from the original year to 2021 using the IMF’s World Economic Outlook Database deflator index of gross domestic product (GDP). Then the original currency was converted to 2021 euros using Purchasing Power Parity (PPP) values ​​for GDP. The dominance ranking matrix (DRM) was used to assess the cost-effectiveness of the interventions of the selected studies.

Results

Of 10,314 identified studies, the entire text of 403 full-text studies was screened, from which 362 studies with unfulfilled inclusion criteria were excluded. As a result, 41 studies were selected for final review, of which 20 studies, 10 studies, and 11 studies were of high, good, and moderate quality, respectively. Ten studies assessed the costs of the SARS-CoV-2 pandemic and 31 studies assessed the cost-effectiveness of surveillance, preparedness and response to COVID-19.

In Italy, temporary and permanent productivity losses due to COVID-19 have been estimated at €1,029 per case and €84,836 per death, respectively. During the first phase of COVID-19, higher costs have been incurred due to the unavailability of vaccines. In Ohio, the cost of lives lost was ~€7.8 billion. For children hospitalized due to COVID-19 in Korea, the total cost was €252,389 and for inpatient facilities, the cost was estimated at €19,513 during an eight-month hospital stay.

The costs were higher (€21,850) for admission to the intensive care unit (ICU) without invasive mechanical ventilation (IMV) and even higher (€62,139) when ICU and IMV were used. Likewise, in Turkey, the cost per patient in ICU was much higher than for ward patients and was estimated at €2,322 and €700 for 15 days and 9 days of hospitalization, respectively.

In Australia, the cost estimates for delays in initiating cancer treatment related to COVID-19 by three and six months were >€6 million and >€25 million, respectively. In Europe, the cost of treating COVID-19 was higher for obese and diabetic people. Initiating treatment at an effective reproduction number (Re) of 3.5 was cost effective from a societal perspective when 75% of symptomatic cases were treated (ICER €2,690/QALY saved) and from a third-party payer perspective when > 50% of all patients treated (ICER ≤€6,267/QALY saved).

Quarantine for symptomatic people further reduced costs. For home isolation, costs have been estimated at 5% of US GDP, with maximum cost savings at a 45-day isolation period and 90% compliance. The cost per life year saved for non-rigorous and rigorous restraint measures for 26 weeks was €206,888 and €1,553,988, respectively. For a base reproduction number (R0) of 2, the optimal strategy was daily testing and 14-day isolation. In contrast, for lower R0 (1.5 to 1.8) scores, weekly testing and 1 week isolation were optimal.

In addition, community testing, saliva sampling and testing of all symptomatic individuals improved cost minimization than standard hospital testing, nasopharyngeal swab testing and testing only of COVID-19 patients requiring hospitalization. The cost per infection avoided by home antigen testing was €6,266, and daily screening followed by polymerase chain reaction (PCR) testing also reduced costs. Investments in personal protective equipment (PPE) of €7.6 billion, dexamethasone treatment and the provision of intensive care beds reduced the economic impact of COVID-19.

In Israel, national lockdowns improved health outcomes by reducing deaths; However, the economic burden increased with an estimated cost of €36,568,451 per death averted and €3.6 million cost per QALY gained. A full lockdown for four months (further extended by three months) cost €116bn.

The estimated losses for the three-month mitigation scenario and the suppression scenario were 13.5% and 22% of GDP, respectively. Oppressive policies were associated with an ICER of

Overall, the study results highlighted the economic burden of SARS-CoV-2 on healthcare systems, societies, the general population and specific population subgroups, and showed that strategies to provide intensive care beds, community screening, immunization and investment in PPE were cost-effective in most cases.

*Important NOTE

medRxiv publishes preliminary scientific reports that are not peer-reviewed and therefore should not be relied upon as conclusive, guide clinical practice/health behavior, or be treated as established information.

Magazine reference:

  • The cost of the COVID-19 pandemic versus the cost-effectiveness of mitigation strategies in EU/UK/EEA and OECD countries: a systematic review. Constantine Vardavas, Konstantinos Zisis, Katerina Nikitara, Ioanna Lagou, Katerina Aslanoglou, Kostas Athanasakis, Revati Phalkey, Jo Leonardi-Bee, Esteve Fernandez, Orla Condell, Favelle Lamb, Frank Sandmann, Anastasia Pharris, Charlotte Deogan, Jonathan E. Suk. medRxiv Preprint 2022, DOI: https://doi.org/10.1101/2022.05.31.22275813, https://www.medrxiv.org/content/10.1101/2022.05.31.22275813v1
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