Quality-Adjusted Life-Year Losses Averted With Every COVID-19 Infection Prevented in the United States

Mobile Distribution of COVID-19 Vaccines to Migrant Farmworkers in Minnesota

The COVID-19 pandemic has disproportionately impacted migrant farmworkers (MFWs). MFWs have experienced higher rates of infection and death than any other occupational group in the United States due to workplace exposure risks, overcrowded housing, and limited access to personal protective equipment. Barriers to accessing COVID-19 vaccines have also contributed to these disparities, especially in rural areas where the pandemic's impact has been devastating. Mobile health clinics, in partnership with community-based organizations, are an effective method for vaccine distribution to rural communities where many MFWs live and work. Between June 2021 and October 2022, the University of Minnesota's Mobile Health Initiative (MHI) organized health fairs in southern Minnesota to distribute vaccines to MFWs and their families. The success of these events can be attributed to partnering with trusted local organizations, bridging geographic barriers, ensuring language-concordant care, and offering multiple health services in one place. MHI's health fairs serve as a model for future mobile vaccination events. As the COVID-19 pandemic has ended as of this time, future pandemics may occur, and equitable vaccine access must be a priority for MFWs. Mobile health clinics are an essential tool to achieving this goal.

Economic Analysis of Border Control Policies during COVID-19 Pandemic: A Modelling Study to Inform Cross-Border Travel Policy between Singapore and Thailand

With countries progressing towards high COVID-19 vaccination rates, strategies for border reopening are required. This study focuses on Thailand and Singapore, two countries that share significant tourism visitation, to illustrate a framework for optimizing COVID-19 testing and quarantine policies for bilateral travel with a focus on economic recovery. The timeframe is the month of October 2021, when Thailand and Singapore were preparing to reopen borders for bilateral travel. This study was conducted to provide evidence for the border reopening policy decisions. Incremental net benefit (INB) compared to the pre-opening period was quantified through a willingness-to-travel model, a micro-simulation COVID-19 transmission model and an economic model accounting for medical and non-medical costs/benefits. Multiple testing and quarantine policies were examined, and Pareto optimal (PO) policies and the most influential components were identified. The highest possible INB for Thailand is US $125.94 million, under a PO policy with no quarantine but with antigen rapid tests (ARTs) pre-departure and upon arrival to enter both countries. The highest possible INB for Singapore is US $29.78 million, under another PO policy with no quarantine on both sides, no testing to enter Thailand, and ARTs pre-departure and upon arrival to enter Singapore. Tourism receipts and costs/profits of testing and quarantine have greater economic impacts than that from COVID-19 transmission. Provided healthcare systems have sufficient capacity, great economic benefits can be gained for both countries by relaxing border control measures.

Cost benefit analysis of alternative testing and quarantine policies for travelers for infection control: A case study of Singapore during the COVID-19 pandemic

Background

Border control mitigates local infections but bears a heavy economic cost, especially for tourism-reliant countries. While studies have supported the efficacy of border control in suppressing cross-border transmission, the trade-off between costs from imported and secondary cases and from lost economic activities has not been studied. This case study of Singapore during the COVID-19 pandemic aims to understand the impacts of varying quarantine length and testing strategies on the economy and health system. Additionally, we explored the impact of permitting unvaccinated travelers to address emerging equity concerns. We assumed that community transmission is stable and vaccination rates are high enough that inbound travelers are not dissuaded from traveling.

Methods

The number of travelers was predicted considering that longer quarantine reduces willingness to travel. A micro-simulation model predicted the number of COVID-19 cases among travelers, the resultant secondary cases, and the probability of being symptomatic in each group. The incremental net monetary benefit (INB) of Singapore was quantified under each border-opening policy compared to pre-opening status, based on tourism receipts, cost/profit from testing and quarantine, and cost and health loss due to COVID-19 cases.

Results

Compared to polymerase chain reaction (PCR), rapid antigen test (ART) detects fewer imported cases but results in fewer secondary cases. Longer quarantine results in fewer cases but lower INB due to reduced tourism receipts. Assuming the proportion of unvaccinated travelers is small (8% locally and 24% globally), allowing unvaccinated travelers will accrue higher INB without exceeding the intensive care unit (ICU) capacity. The highest monthly INB from all travelers is $2,236.24 m, with 46.69 ICU cases per month, achieved with ARTs at pre-departure and on arrival without quarantine. The optimal policy in terms of highest INB is robust under changes to various model assumptions. Among all cost-benefit components, the top driver for INB is tourism receipts.

Conclusions

With high vaccination rates locally and globally alongside stable community transmission, opening borders to travelers regardless of vaccination status will increase economic growth in the destination country. The caseloads remain manageable without exceeding ICU capacity, and costs of cases are offset by the economic value generated from travelers.

Economic evaluation of COVID-19 rapid antigen screening programs in the workplace

BACKGROUND

Diagnostic testing has been pivotal in detecting SARS-CoV-2 infections and reducing transmission through the isolation of positive cases. We quantified the value of implementing frequent, rapid antigen (RA) testing in the workplace to identify screening programs that are cost-effective.

METHODS

To project the number of cases, hospitalizations, and deaths under alternative screening programs, we adapted an agent-based model of COVID-19 transmission and parameterized it with the demographics of Ontario, Canada, incorporating vaccination and waning of immunity. Taking into account healthcare costs and productivity losses associated with each program, we calculated the incremental cost-effectiveness ratio (ICER) with quality-adjusted life year (QALY) as the measure of effect. Considering RT-PCR testing of only severe cases as the baseline scenario, we estimated the incremental net monetary benefits (iNMB) of the screening programs with varying durations and initiation times, as well as different booster coverages of working adults.

RESULTS

Assuming a willingness-to-pay threshold of CDN$30,000 per QALY loss averted, twice weekly workplace screening was cost-effective only if the program started early during a surge. In most scenarios, the iNMB of RA screening without a confirmatory RT-PCR or RA test was comparable or higher than the iNMB for programs with a confirmatory test for RA-positive cases. When the program started early with a duration of at least 16 weeks and no confirmatory testing, the iNMB exceeded CDN$1.1 million per 100,000 population. Increasing booster coverage of working adults improved the iNMB of RA screening.

CONCLUSIONS

Our findings indicate that frequent RA testing starting very early in a surge, without a confirmatory test, is a preferred screening program for the detection of asymptomatic infections in workplaces.

Valuing COVID-19 Morbidity Risk Reductions

Many economic analyses, including those that address the COVID-19 pandemic, focus on the value of averting deaths and do not include the value of averting nonfatal illnesses. Yet incorporating the value of averting nonfatal cases may change conclusions about the desirability of the policy. While per case values may be small, the number of nonfatal cases is often large, far outstripping the number of fatal cases. The value of averting nonfatal cases is also increasingly important in evaluating COVID-19 policy options as vaccine- and infection-related immunity and treatments reduce the case-fatality rate. Unfortunately, little valuation research is available that explicitly addresses COVID-19 morbidity. We describe and implement an approach for approximating the value of averting nonfatal illnesses or injuries and apply it to COVID-19 in the United States. We estimate gains from averting COVID-19 morbidity of about 0.01 quality-adjusted life year (QALY) per mild case averted, 0.02 QALY per severe case, and 3.15 QALYs per critical case. These gains translate into monetary values of about $5,300 per mild case, $11,000 per severe case, and $1.8 million per critical case. While these estimates are imprecise, they suggest the magnitude of the effects.

A Systematic Review of Economic Evaluations of COVID-19 Interventions: Considerations of Non-Health Impacts and Distributional Issues

OBJECTIVES

This study aims to conduct a systematic review of economic evaluations of COVID-19 interventions and to examine whether and how these studies incorporate non-health impacts and distributional concerns.

METHODS

We searched the National Institutes of Health's COVID-19 Portfolio as of May 20, 2021, and supplemented our search with additional sources. We included original articles, including preprints, evaluating both the health and economic effects of a COVID-19-related intervention. Using a pre-specified data collection form, 2 reviewers independently screened, reviewed, and extracted information about the study characteristics, intervention types, and incremental cost-effectiveness ratios (ICERs). We used an Impact Inventory to catalog the types of non-health impacts considered.

RESULTS

We included 70 articles, almost half of which were preprints. Most articles (56%) included at least one non-health impact, but fewer (21%) incorporated non-economic consequences. Few articles (17%) examined subgroups of interest. After excluding negative ICERs, the median ICER for the entire sample (n = 243 ratios) was $67,000/quality-adjusted life-year (QALY) (interquartile range [IQR] $9000-$893,000/QALY). Interventions including a pharmaceutical component yielded a median ICER of $93,000/QALY (IQR $4000-$7,809,000/QALY), whereas interventions including a non-pharmaceutical component were slightly more cost-effective overall with a median ICER of $81,000/QALY (IQR $12,000-$1,034,000/QALY). Interventions reported to be highly cost-effective were treatment, public information campaigns, quarantining identified contacts/cases, canceling public events, and social distancing.

CONCLUSIONS

Our review highlights the lack of consideration of non-health and distributional impacts among COVID-19-related economic evaluations. Accounting for non-health impacts and distributional effects is essential for comprehensive assessment of interventions' value and imperative for generating cost-effectiveness evidence for both current and future pandemics.

Quality-Adjusted Life-Years Lost Due to COVID-19 Mortality: Methods and Application for The Netherlands

OBJECTIVES

The COVID-19 pandemic has increased mortality worldwide considerably in 2020. Nevertheless, it is unknown how the increase in mortality translates into a loss in quality-adjusted life-years (QALYs), which is a function of age and the health condition of the deceased patient at time of death. We estimate the QALYs lost in The Netherlands as a result of deaths because of COVID-19 in 2020.

METHODS

As a starting point, we use estimates of underlying diseases and the number of COVID-19 deaths in nursing homes as a proxy for underlying health status. In a next step, these are combined with estimates of excess mortality rates and quality of life for different groups to calculate QALYs lost. We compare the results with an alternative scenario, in which COVID-19 deaths occurred randomly across the population regardless of underlying conditions. For this alternative scenario, we use population mortality and average quality of life by age and sex.

RESULTS

Accounting for underlying health status, we estimate that QALYs lost because of COVID-19 mortality are on average 3.9 per death for men and 3.5 for women. This is approximately 3.5 QALYs less than when not taking selective mortality into account. Given 16 308 excess deaths, this translates into 61 032 QALYs lost because of COVID-19.

CONCLUSIONS

We conclude that QALYs lost because of COVID-19 mortality are still substantial, even if mortality is strongly concentrated in people with poor health.

A model framework for projecting the prevalence and impact of Long-COVID in the UK

The objective of this paper is to model lost Quality Adjusted Life Years (QALYs) from symptoms arising from COVID-19 disease in the UK population, including symptoms of ‘long-COVID’. The scope includes QALYs lost to symptoms, but not deaths, due to acute COVID-19 and long-COVID. The prevalence of symptomatic COVID-19, encompassing acute symptoms and long-COVID symptoms, was modelled using a decay function. Permanent injury as a result of COVID-19 infection, was modelled as a fixed prevalence. Both parts were combined to calculate QALY loss due to COVID-19 symptoms. Assuming a 60% final attack rate for SARS-CoV-2 infection in the population, we modelled 299,730 QALYs lost within 1 year of infection (90% due to symptomatic COVID-19 and 10% permanent injury) and 557,764 QALYs lost within 10 years of infection (49% due to symptomatic COVID-19 and 51% due to permanent injury). The UK Government willingness-to-pay to avoid these QALY losses would be £17.9 billion and £32.2 billion, respectively. Additionally, 90,143 people were subject to permanent injury from COVID-19 (0.14% of the population). Given the ongoing development in information in this area, we present a model framework for calculating the health economic impacts of symptoms following SARS-CoV-2 infection. This model framework can aid in quantifying the adverse health impact of COVID-19, long-COVID and permanent injury following COVID-19 in society and assist the proactive management of risk posed to health. Further research is needed using standardised measures of patient reported outcomes relevant to long-COVID and applied at a population level.

Effect of easing lockdown and restriction measures on COVID-19 epidemic projection: A case study of Saudi Arabia

OBJECTIVES

In this study we compared two predictions of COVID-19 cases in the Kingdom Saudi Arabia (KSA) using pre-and post-relaxation of lockdown period data to provide an insight regarding rational exit strategies. We also applied these projections to understand economic costs versus health benefit of lockdown measures.

METHODS

We analyzed open access data on COVID-19 cases from March 6 to January 16, 2021 in the KSA. To understand the epidemic projection during the pre- and post-lockdown period, we used two types of modeling: the SIR model, and the time series model. We also estimated the costs and benefits of lockdown- QALY gained compared to the costs of lockdown considering the payment threshold of the Government.

RESULTS

Prediction using lockdown period data suggested that the epidemic might slow down significantly after 109 thousand cases and end on October 6, 2020. However, analysis with latest data after easing lockdown measures suggested that epidemic might be close to an end on October 28, 2021 with 358 thousand cases. The peak has also been shifted from May 18, 2020 to Jun 24, 2020. While earlier model predicted a steady growth in mid-June, the revised model with latest data predicted it in mid-August. In addition, we estimated that 4986 lives would have been saved if lockdown continued but the cost per life saved would be more than $378 thousand, which is way above not only the KSA threshold, but also the threshold of any other highly advanced economies such as the UK and the USA.

CONCLUSIONS

Our results suggest that relaxation of lockdown measures negatively impacts the epidemic. However, considering the negative impact of prolong lockdown measures on health and economy, countries must decide on the best timing and strategy to exit from such measures to safely return to normal life with minimum loss of lives and economy considering its economic and health systems' capacity. Instead of focusing only on health, a balanced approach taking economy under consideration is recommended.