Cost-effectiveness of emergency preparedness measures in response to infectious respiratory disease outbreaks: a systematic review and econometric analysis

Abstract

ObjectivesRespiratory infectious disease outbreaks pose a threat for loss of life, economic instability and social disruption. We conducted a systematic review of published econometric analyses to assess the direct and indirect costs of infectious respiratory disease outbreaks that occurred between 2003 and 2019.SettingRespiratory infectious disease outbreaks or public health preparedness measures or interventions responding to respiratory outbreaks in OECD countries (excluding South Korea and Japan) so as to assess studies relevant to the European context. The cost-effectiveness of interventions was assessed through a dominance ranking matrix approach. All cost data were adjusted to the 2017 Euro, with interventions compared with the null. We included data from 17 econometric studies.Primary and secondary outcome measuresDirect and indirect costs for disease and preparedness and/or response or cost-benefit and cost-utility were measured.ResultsOverall, the economic burden of infectious respiratory disease outbreaks was found to be significant to healthcare systems and society. Indirect costs were greater than direct costs mainly due to losses of productivity. With regard to non-pharmaceutical strategies, prehospitalisation screening and the use of protective masks were identified as both an effective strategy and cost-saving. Community contact reduction was effective but had ambiguous results for cost saving. School closure was an effective measure, but not cost-saving in the long term. Targeted antiviral prophylaxis was the most cost-saving and effective pharmaceutical intervention.ConclusionsOur cost analysis results provide evidence to policymakers on the cost-effectiveness of pharmaceutical and non-pharmaceutical intervention strategies which may be applied to mitigate or respond to infectious respiratory disease outbreaks.

The cost of the COVID-19 pandemic vs the cost-effectiveness of mitigation strategies in the EU/UK/EEA and OECD countries: a systematic review

“…A systematic review on previous respiratory infectious disease outbreaks prior to COVID-19 (56) concluded to similar results by pointing out the significant burden of both direct and indirect medical costs for management and response activities. Most direct costs occured from the additional personnel hours, the response planning and contact tracing activities, the provision of training and educational materials and the laboratory costs.…”

“…Most direct costs occured from the additional personnel hours, the response planning and contact tracing activities, the provision of training and educational materials and the laboratory costs. Indirect costs were greater than direct ones, particularly when school closures and/or workplace closures were implemented, due to lower productivity (56). However, given the strictness of the NPIs in COVID-19 pandemic the economic burden has been found to be high for primary production sectors including industries associated with activities in raw materials extraction, secondary industrial sectors involving the production of finished products and tertiary sectors encompassing service provision industries (57).…”

Descriptive study of causes of death and COVID-19-associated morbidities from the New York City electronic death record: first wave of the pandemic March–July 2020

“…Not only did chronic ischaemic heart disease, hypertension, pneumonia and diabetes display strong statistically remarkable deviations from reference, but these conditions are also prominent morbidities noted in the context of COVID-19 deaths. There is also the possibility that the increase in non-COVID-19 deaths may be partially due to indirect effects related to the pandemic response from several dimensions (eg, incomplete knowledge by healthcare providers of COVID-19 as a novel condition impacting treatment strategies, policy implementation, lockdowns, social and economic dislocations, treatment and lapses in care) 21–28. However, although plausible, our analysis is inadequate to inform on this issue in a dispositive manner.…”

Effectiveness of non-pharmaceutical interventions on SARS-CoV-2 transmission during the period January 2021 until May 2022: A systematic literature review

“…Specifically, two meta-analyses with a previous cut-off date from our systematic review documented a preventive effect of face masks against COVID-19 in healthcare workers and the general population (24, 25). Also, face masks were found to be important as a preventative strategy, especially when population compliance is high, according to our team’s prior systematic analysis of the cost-effectiveness of public health emergency preparedness strategies (26). These findings are also corroborated by research on previous respiratory infectious diseases.…”