In a recent study review posted to the medRxiv* preprint server, researchers evaluated the economic and medical costs incurred due to the coronavirus disease 2019 (COVID-19) pandemic. They also assessed the cost-effectiveness of surveillance, response measures, and preparedness for COVID-19.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections have caused economic disruptions, loss of lives, and social disturbances with a profound impact on healthcare systems, societies, and the general population. Data on the economic impact of COVID-19 is indispensable for improving decision-making and allocating resources for enhanced preparation for COVID-19 and future pandemics.
About the study
In the present systematic review, researchers assessed the economic burden of COVID-19 on healthcare systems, societies, the general population, and within-population subgroups in Europe, the United Kingdom, and member nations of the European environment agency (EEA) and the organization for economic cooperation and development (OECD).
Studies published in the EMBASE and Ovid Medline databases between January 1, 2020, and April 22, 2021, were selected to determine the costs incurred due to COVID-19 and the cost benefits of pharmaceutical and non-pharmaceutical interventions (NPIs). Public health preparedness measures or interventions were compared to cost of inaction/no intervention and cost of preparedness vs. cost of response. The outcome measures of economic evaluations included cost for each life-year gained, the cost for each quality-adjusted life-year (QALY) achieved, and the cost for cases averted with the interventions. In addition, the incremental cost-effectiveness ratio (ICER) was evaluated.
For the analysis, first, the costs were inflated from the original year to 2021, using the gross domestic product (GDP) deflator index of the International Monetary Fund World Economic Outlook Database. Subsequently, the original currency was converted to 2021 Euros, using the Purchasing Power Parities (PPP) values for GDP. The dominance ranking matrix (DRM) was used to assess the cost-effectiveness of the interventions of the selected studies.
Out of 10,314 studies identified, the entire text of 403 full-text studies was screened, from which 362 studies with unmet inclusion criteria were excluded. As a result, 41 studies were selected for the final review, of which 20 studies, 10 studies, and 11 studies were of high, good, and medium quality, respectively. Ten studies assessed the costs of the SARS-CoV-2 pandemic, and 31 studies evaluated the cost-benefits of surveillance, preparedness, and measures taken in response to COVID-19.
In Italy, the temporary and permanent productivity losses due to COVID-19 were estimated at 1,029 € per case and 84,836 € per death, respectively. Higher costs were incurred during the initial COVID-19 phase due to vaccine unavailability. In Ohio, the cost of lives lost was ~7.8 billion €. For children hospitalized due to COVID-19 in Korea, the total costs were 252,389 € and for inpatient settings, the cost was estimated at 19,513 € during eight months of hospitalization.
The costs were higher (21,850 €) in case of intensive care unit (ICU) admissions without invasive mechanical ventilation (IMV) and even higher (62,139 €) if ICU and IMV are used. Likewise, in Turkey, the cost per ICU patient was much higher than ward patients and was estimated at 2,322 € and 700 € for 15 days and nine days of hospitalization, respectively.
In Australia, the cost estimates for delays in COVID-19-related cancer treatment initiation by three months and six months were >6 million € and >25 million €, respectively. In Europe, COVID-19 treatment costs were higher for obese and diabetic individuals. Initiating treatment at an effective reproduction number (Re) of 3.5 was cost-effective from the societal perspective when treating 75% of symptomatic cases (ICER 2,690 €/QALY saved) and from the third payer perspective when >50% of all patients were treated (ICER ≤6,267 €/QALY saved).
Quarantine for symptomatic individuals further reduced costs. With home isolation, the costs were estimated at 5% of the US GDP, with maximum cost savings in the case of a 45-day isolation period and 90% compliance. The cost per life-year saved for non-strict and strict physical restriction policies for 26 weeks was 206,888 € and 1,553,988 €, respectively. For a basic reproduction number (R0) of 2, the optimal strategy was daily testing and 14-day-isolation. On contrary, for lower R0 (1.5 to 1.8) values, weekly testing and one-week isolation were optimal.
Further, community testing, saliva sampling, and testing of all symptomatic individuals improved cost-minimization than standard hospital testing, nasopharyngeal swab sampling, and testing only COVID-19 patients requiring hospitalization. The cost per infection averted by home-based antigen tests was 6,266 € and daily screening with subsequent polymerase chain reaction (PCR) tests also reduced costs. Personal protective equipment (PPE) investments of 7.6 billion €, dexamethasone treatment, and provision of ICU beds reduced the economic impact of COVID-19.
In Israel, national lockdowns improved health outcomes by reducing deaths; however, the economic burden increased with estimated costs of 36,568,451 € per death averted, and 3.6 million € costs per QALY gained. Complete lockdown for four months (further extended for three months) resulted in costs of 116 billion € and the gradual lifting of restrictions would reduce GDP by 697,121 € /life-year saved.
The estimated losses for the three-month mitigation scenario and suppression scenario were 13.5% and 22% in GDP, respectively. Suppression policies were associated with an ICER of <56 972 €. In the United States (US), the universal vaccination approach was more cost-saving than the risk-stratification approach from the societal perspective (estimated cost savings of 395 million €); however, the latter was more cost-effective from the healthcare perspective.
Overall, the study findings highlighted the economic burden of SARS-CoV-2 on healthcare systems, societies, the general population, and specific population subgroups and showed that ICU bed provision policies, community screening, vaccination, and investing in PPE were cost-effective in most cases.