Cost-effectiveness and return on investment of protecting health workers in low- and middle-income countries during the COVID-19 pandemic

Abstract

Background: In this paper, we predict the health and economic consequences of immediate investment in personal protective equipment (PPE) for health care workers (HCWs) in low- and middle-income countries (LMICs). Methods: To account for health consequences, we estimated mortality for health care workers (HCW), and present a cost-effectiveness and return on investment (ROI) analysis using a decision-analytic model with Bayesian multivariate sensitivity analysis and Monte Carlo simulation. Inputs were used from the World Health Organization Essential Supplies Forecasting Tool and the Imperial College of London epidemiologic model. Results: An investment of $9.6 billion USD would adequately protect HCWs in all LMICs. This intervention saves 2,299,543 lives across LMICs, costing $59 USD per HCW case averted and $4,309 USD per HCW life saved. The societal ROI is $755.3 billion USD, the equivalent of a 7,932% return. Regional and national estimates are also presented. In scenarios where PPE remains scarce, 70-100% of HCWs will get infected, irrespective of nationwide social distancing policies. Maintaining HCW infection rates below 10% and mortality below 1% requires inclusion of a PPE scale-up strategy as part of the pandemic response. Discussion: In conclusion, wide-scale procurement and distribution of PPE for LMICs is an essential strategy to prevent widespread HCW morbidity and mortality. It is cost-effective and yields a large downstream ROI.

Economic evaluation of programs against COVID-19: A systematic review

“…Overall, 26 articles were included in this review. Most of these studies were from the US (n =9)( 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ), followed by China (n = 4)( 4 , 23 , 24 , 25 ), the UK (n =2)( 26 , 27 ), Germany(n =2)( 28 , 29 ), India (n =2)( 30 , 31 ), Australia (n =1)( 32 ), Israel (n = 1)( 33 ), Morocco (n = 1)( 34 ), Ghana (n = 1)( 35 ), South Africa (n=1)( 36 ), Uganda (n=1)( 37 ), Thailand (n=1)( 38 ).…”

“…Eighteen studies assessed the programs against COVID-19 in the whole population( 4 , 14 , 16 , 20 , 21 , 22 , 23 , 24 , 26 , 28 , 30 , 32 , 33 , 34 , 35 , 36 , 37 ), four studies evaluated preventing programs among patients with COVID-19( 25 , 27 , 29 , 38 ), two studies focused on the healthcare workers (HCWs)( 17 , 18 ), one study on the academic students( 19 ) and last one on the patients with allergic rhinitis( 15 ).…”

“…The three common strategies in most of the included studies were quarantine (n=10)( 4 , 22 , 23 , 24 , 30 , 31 , 33 , 34 , 35 , 36 ), screening and diagnostic tests (n=8)( 17 , 19 , 21 , 25 , 26 , 35 , 36 , 38 ), and social distancing (n=7)( 14 , 15 , 16 , 20 , 24 , 33 , 35 ) which they were evaluated for both target groups (such as high risk or forefront healthcare workers, and academic students) and the general population. A handful of studies evaluated PPE (n = 5)( 17 , 18 , 23 , 35 , 37 ) and isolation (n = 6)( 4 , 22 , 23 , 32 , 34 , 36 ). Three studies examined treatment and vaccination of COVID-19( 20 , 27 , 29 ).…”

“…The majority of included studies were from the social perspective (n =8)( 4 , 15 , 18 , 20 , 22 , 28 , 29 , 30 ). Six studies performed from the healthcare system perspective ( 4 , 15 , 21 , 25 , 27 , 36 ).…”

Evaluating Healthcare Workers Needs and Empowering Them During Pandemics.

“…Personal protective equipment (PPE) shortage increased as the virus continue to spread. Frontline health workers have limited access to protective gear such as N-95 masks and gowns [23]. Optimization for PPE is the use of reusable PPE after disinfecting using sterilization technique, and the use of PPE beyond manufacturer instruction for training [24].…”