Disease Burden Attributable to the First Wave of COVID-19 in China and the Effect of Timing on the Cost-Effectiveness of Movement Restriction Policies

Abstract

Objectives Movement restriction policies (MRPs) are effective in preventing/delaying COVID-19 transmission but are associated with high societal cost. This study aims to estimate the health burden of the first wave of COVID-19 in China and the cost-effectiveness of early versus late implementation of MRPs to inform preparation for future waves. Methods The SEIR (susceptible, exposed, infectious, and recovered) modeling framework was adapted to simulate the health and cost outcomes of initiating MRPs at different times: rapid implementation (January 23, the real-world scenario), delayed by 1 week, delayed by 2 weeks, and delayed by 4 weeks. The end point was set as the day when newly confirmed cases reached zero. Two costing perspectives were adopted: healthcare and societal. Input data were obtained from official statistics and published literature. The primary outcomes were disability-adjusted life-years, cost, and net monetary benefit. Costs were reported in both Chinese renminbi (RMB) and US dollars (USD) at 2019 values. Results The first wave of COVID-19 in China resulted in 38 348 disability adjusted life-years lost (95% CI 19 417-64 130) and 2639 billion RMB losses (95% CI 1347-4688). The rapid implementation strategy dominated all other delayed strategies. This conclusion was robust to all scenarios tested. At a willingness-to-pay threshold of 70 892 RMB (the national annual GDP per capita) per disability-adjusted life-year saved, the probability for the rapid implementation to be the optimal strategy was 96%. Conclusions Early implementation of MRPs in response to COVID-19 reduced both the health burden and societal cost and thus should be used for future waves of COVID-19.

Disability-adjusted life years (DALYs) due to the direct health impact of COVID-19 in India, 2020

“…Mortality contributed (99.61%) towards almost all the DALYs due to the direct impact of COVID-19 in India, in line with other studies 49,54,57 . There was a median of 31.67 YLLs per COVID-19 death in India.…”

Cost-Effectiveness of COVID-19 Policy Measures: A Systematic Review

“…The CHEC quality assessment was performed for each included study (see Appendix 3 in Supplemental Materials found at https://doi.org/10.1016/j.jval.2021.05.013 ). Nine studies scored high (>13/19), 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 10 studies scored moderate, 19 , 20 , 21 , 22 , 23 , 24 , 25 and 4 studies scored low (≤6/19). 26 , 27 …”

“…A national lockdown has a moderate advantage in saving lives with tremendous costs and possible overwhelming economic effects. 8 Zhao et al 13 (China) General population Current practice: the real-world scenario in China, where the first movement restriction policies started on January 23, 2020 and ended on March 25, 2020 1-week delay in the imposition of movement restriction policies (MRPs) (MRPs end on the day when national newly confirmed cases reach zero) 2-week delay in the imposition of MRPs (MRPs end on the day when national newly confirmed cases reach zero) 4-week delay in the imposition of MRPs (MRPs end on the day when national newly confirmed cases reach zero) Extended SIRD—(S) susceptible, (Ip) presymptomatic, (Im) infectious with mild symptoms, (Ih) hospitalized, (R) recovered, and (D) deceased Net benefit (WTP = 70 892 RMB) Cost-benefit Period less than a year Societal and healthcare perspective Strategy A (“current practice”) dominates all other strategies, from both a healthcare perspective and societal perspective. At a WTP of 70 892 RMB per DALY averted, the probability that strategy A is more cost-effective compared with strategy B, C, and D is 96%, 99%, 100%, respectively.…”

Despite vaccination, China needs non-pharmaceutical interventions to prevent widespread outbreaks of COVID-19 in 2021

“…In 2020, epidemic suppression and/or mitigation have relied on non-pharmaceutical interventions (NPIs), including social distancing, school closure, mask use and case isolation. Although effective and widely adopted to limit severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission and reduce COVID-19 burden, these interventions entail enormous economic costs and negatively affect quality of life 2 . Additionally, in many countries, relaxation of NPIs has led to a resurgence of the epidemic as herd immunity has not been reached thus far 3 .…”