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Chang E, Li H, Zheng W, Zhou L, Jia Y, Gu W, Cao Y, Zhu X, Xu J, Liu B, You M, Liu K, Wang M, Huang W. Economic Evaluation of COVID-19 Immunization Strategies: A Systematic Review and Narrative Synthesis. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:457-470. [PMID: 38598091 DOI: 10.1007/s40258-024-00880-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/17/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES This study aimed to systematically assess global economic evaluation studies on COVID-19 vaccination, offer valuable insights for future economic evaluations, and assist policymakers in making evidence-based decisions regarding the implementation of COVID-19 vaccination. METHODS Searches were performed from January 2020 to September 2023 across seven English databases (PubMed, Web of Science, MEDLINE, EBSCO, KCL-Korean Journal Dataset, SciELO Citation Index, and Derwent Innovations Index) and three Chinese databases (Wanfang Data, China Science and Technology Journal, and CNKI). Rigorous inclusion and exclusion criteria were applied. Data were extracted from eligible studies using a standardized data collection form, with the reporting quality of these studies assessed using the Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022). RESULTS Of the 40 studies included in the final review, the overall reporting quality was good, evidenced by a mean score of 22.6 (ranging from 10.5 to 28). Given the significant heterogeneity in fundamental aspects among the studies reviewed, a narrative synthesis was conducted. Most of these studies adopted a health system or societal perspective. They predominantly utilized a composite model, merging dynamic and static methods, within short to medium-term time horizons to simulate various vaccination strategies. The research strategies varied among studies, investigating different doses, dosages, brands, mechanisms, efficacies, vaccination coverage rates, deployment speeds, and priority target groups. Three pivotal parameters notably influenced the evaluation results: the vaccine's effectiveness, its cost, and the basic reproductive number (R0). Despite variations in model structures, baseline parameters, and assumptions utilized, all studies identified a general trend that COVID-19 vaccination is cost-effective compared to no vaccination or intervention. CONCLUSIONS The current review confirmed that COVID-19 vaccination is a cost-effective alternative in preventing and controlling COVID-19. In addition, it highlights the profound impact of variables such as dose size, target population, vaccine efficacy, speed of vaccination, and diversity of vaccine brands and mechanisms on cost effectiveness, and also proposes practical and effective strategies for improving COVID-19 vaccination campaigns from the perspective of economic evaluation.
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Affiliation(s)
- Enxue Chang
- School of Health Management, Harbin Medical University, Harbin, China
| | - Haofei Li
- School of Health Management, Harbin Medical University, Harbin, China
| | - Wanji Zheng
- School of Health Management, Harbin Medical University, Harbin, China
| | - Lan Zhou
- School of Health Management, Harbin Medical University, Harbin, China
| | - Yanni Jia
- School of Health Management, Harbin Medical University, Harbin, China
| | - Wen Gu
- School of Health Management, Harbin Medical University, Harbin, China
| | - Yiyin Cao
- School of Health Management, Harbin Medical University, Harbin, China
| | - Xiaoying Zhu
- School of Elderly Care Services and Management, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
- Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
| | - Juan Xu
- Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen Center, Shenzhen, China
| | - Bo Liu
- Shenzhen Health Capacity Building and Continuing Education Center, Shenzhen, China
| | - Mao You
- National Health Development Research Center, Beijing, 100191, China
| | - Kejun Liu
- National Health Development Research Center, Beijing, 100191, China.
| | - Mingsi Wang
- School of Health Management, Harbin Medical University, Harbin, China.
| | - Weidong Huang
- School of Health Management, Harbin Medical University, Harbin, China.
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Yerramilli P, Chopra M, Rasanathan K. The cost of inaction on health equity and its social determinants. BMJ Glob Health 2024; 9:e012690. [PMID: 38589049 PMCID: PMC11015166 DOI: 10.1136/bmjgh-2023-012690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/25/2023] [Indexed: 04/10/2024] Open
Abstract
Rising levels of inflation, debt and macrofiscal tightening are putting expenditures on the social sectors including health under immense scrutiny. Already, there are worrying signs of reductions in social sector investments. However, even before the pandemic, evidence showed the significant returns on investments in health equity and its social determinants. Emerging data and trends show that these potential returns have increased during the COVID-19 pandemic - investments in social determinants can mitigate widespread reductions in human capital and the increasing likelihood of costly syndemics, while promoting access to healthcare innovations that have thus far been inequitably distributed. Therefore, we argue that, despite immediate fiscal pressures, this is exactly the time to invest in health equity and its broader social determinants, as the returns on such investments have never been greater.
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Affiliation(s)
- Pooja Yerramilli
- Department of Medicine, GWU School of Medicine and Health Sciences, Washington, DC, USA
- Health, Nutrition, and Population, World Bank Group, Washington, DC, USA
| | - Mickey Chopra
- Health, Nutrition, and Population, World Bank Group, Washington, DC, USA
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Faramarzi A, Norouzi S, Dehdarirad H, Aghlmand S, Yusefzadeh H, Javan-Noughabi J. The global economic burden of COVID-19 disease: a comprehensive systematic review and meta-analysis. Syst Rev 2024; 13:68. [PMID: 38365735 PMCID: PMC10870589 DOI: 10.1186/s13643-024-02476-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 01/31/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has caused a considerable threat to the economics of patients, health systems, and society. OBJECTIVES This meta-analysis aims to quantitatively assess the global economic burden of COVID-19. METHODS A comprehensive search was performed in the PubMed, Scopus, and Web of Science databases to identify studies examining the economic impact of COVID-19. The selected studies were classified into two categories based on the cost-of-illness (COI) study approach: top-down and bottom-up studies. The results of top-down COI studies were presented by calculating the average costs as a percentage of gross domestic product (GDP) and health expenditures. Conversely, the findings of bottom-up studies were analyzed through meta-analysis using the standardized mean difference. RESULTS The implemented search strategy yielded 3271 records, of which 27 studies met the inclusion criteria, consisting of 7 top-down and 20 bottom-up studies. The included studies were conducted in various countries, including the USA (5), China (5), Spain (2), Brazil (2), South Korea (2), India (2), and one study each in Italy, South Africa, the Philippines, Greece, Iran, Kenya, Nigeria, and the Kingdom of Saudi Arabia. The results of the top-down studies indicated that indirect costs represent 10.53% of GDP, while the total estimated cost accounts for 85.91% of healthcare expenditures and 9.13% of GDP. In contrast, the bottom-up studies revealed that the average direct medical costs ranged from US $1264 to US $79,315. The meta-analysis demonstrated that the medical costs for COVID-19 patients in the intensive care unit (ICU) were approximately twice as high as those for patients in general wards, with a range from 0.05 to 3.48 times higher. CONCLUSIONS Our study indicates that the COVID-19 pandemic has imposed a significant economic burden worldwide, with varying degrees of impact across countries. The findings of our study, along with those of other research, underscore the vital role of economic consequences in the post-COVID-19 era for communities and families. Therefore, policymakers and health administrators should prioritize economic programs and accord them heightened attention.
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Affiliation(s)
- Ahmad Faramarzi
- Department of Health Economics and Management, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran.
| | - Soheila Norouzi
- Department of Health Economics and Management, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Hossein Dehdarirad
- Department of Medical Library and Information Science, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Siamak Aghlmand
- Department of Health Economics and Management, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Hasan Yusefzadeh
- Department of Health Economics and Management, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Javad Javan-Noughabi
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Di Fabio S, La Torre G. Analysis of the Economic Burden of COVID-19 on the Workers of a Teaching Hospital in the Centre of Italy: Changes in Productivity Loss and Healthcare Costs Pre and Post Vaccination Campaign. Vaccines (Basel) 2023; 11:1791. [PMID: 38140197 PMCID: PMC10747819 DOI: 10.3390/vaccines11121791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/10/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
Introduction: Following the concerning levels of spread and severity of the infection, on 11 March 2020, the World Health Organisation declared the COVID-19 outbreak a pandemic. In response to the pandemic, governments adopted several mitigation strategies. The pandemic posed a great threat to the Italian healthcare workforce (HW), with Italy being one of the hardest-hit countries. The aim of this study is to estimate the economic burden of COVID-19 on the workforce of a teaching hospital in Central Italy. Two periods are compared: 1 March 2020-9 February 2021 vs. 10 February 2021-31 March 2022. Methods: This study is conducted from a societal perspective. The database (n = 3298) of COVID-19-confirmed cases among the HW was obtained from the occupational health office of the hospital. The first entry on the database refers to 1 March 2020. Cost data were used to assess the economic burden of COVID-19 on the hospital workforce. They include two main groups: hourly salaries and medical expenses. The cost of productivity loss, hospital admission, at-home treatments, and contact tracing and screening tests were computed for the first and second periods of the analysis. Results: The total economic burden during the first period is estimated to be around EUR 3.8 million and in the second period EUR 4 million. However, the average cost per person is smaller in the second period (EUR 1561.78) compared to the first one (EUR 5906). In both periods, the cost of productivity loss is the largest component of the economic burden (55% and 57%). The cost of hospital admission decreased by more than 60% in the second period. Conclusion: Outcomes of the analysis suggest that the economic burden of COVID-19 on the HW is higher in the first period of analysis compared to the second period. The main reason could be identified in the shift from more severe and critical confirmed cases to more asymptomatic, mild, and moderate cases. The causes of this shift are not easily detectable. Vaccination, variants of the virus, and an individual's determinants of health could all be causes of the decrease in the economic burden of COVID-19 on the HW. COVID-19 can generate a high economic burden on healthcare workers and, more generally, on HWs. However, a comprehensive estimate of the economic burden of the pandemic needs to integrate the mental health repercussions and the long-term COVID-19 that will become evident in the coming years.
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Affiliation(s)
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
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Bhattacharya P, John D, Mukherjee N, Ms N, Menon J, Banerjee A. Estimation of non-health gross domestic product (NHGDP) loss due to COVID-19 deaths in West Bengal, India. BMJ Open 2023; 13:e072559. [PMID: 37907289 PMCID: PMC10619121 DOI: 10.1136/bmjopen-2023-072559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 09/13/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVES The state of West Bengal witnessed a significant surge of COVID-19 in all three waves. However, there is a gap in understanding the economic loss associated with COVID-19. This study estimates future non-health gross domestic product (NHGDP) losses associated with COVID-19 deaths in West Bengal, India. SETTING Various open domains were used to gather data on COVID-19 deaths in West Bengal and the aforementioned estimates. PRIMARY AND SECONDARY OUTCOME MEASURES The NHGDP losses were evaluated using the cost-of-illness approach. Future NHGDP losses were discounted at 3%. Excess death estimates by the WHO and Global Burden of Disease (GBD) were used. Sensitivity analysis was carried out by varying discount rates and average age of death (AAD). RESULTS 21 532 deaths in West Bengal from 17 March 2020 to 31 December 2022 decreased the future NHGDP by $0.92 billion. Nearly 90% of loss was due to deaths occurring in the age group of 30 years and above. Majority of the NHGDP loss was borne by the 46-60 years age group. NHGDP loss/death was $55,171; however, the average loss/death declined with rise in age. Based on the GBD and WHO excess death estimates, the NHGDP loss increased to $9.38 billion and $9.42 billion, respectively. When the lower age interval is considered as AAD, the NHGDP loss increased to $1.3 billion. At 5% and 10% discount rates, the losses reduced to $0.767 billion and $0.549 billion, respectively. CONCLUSIONS Results from the study suggest that COVID-19 contributed to a major economic loss in West Bengal. The mortality and morbidity caused by COVID-19, the substantial economic costs at individual and population levels in West Bengal, and probably across India and other countries, is another economic argument for better infection control strategies across the globe to minimise the impact of COVID-19.
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Affiliation(s)
- Paramita Bhattacharya
- Centre for Public Health Research, Manbhum Ananda Ashram Nityananda Trust, Kolkata, West Bengal, India
| | - Denny John
- Faculty of Life and Allied Health Sciences, MS Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - Nirmalaya Mukherjee
- Centre for Public Health Research, Manbhum Ananda Ashram Nityananda Trust, Kolkata, West Bengal, India
| | - Narassima Ms
- Great Lakes Institute of Management, Manamai Village, Tamilnadu, India
| | - Jaideep Menon
- Department of Cardiology, Amrita Institute of Medical Sciences & Research Centre, Kochi, Kerala, India
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK
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Swain CK, Rout HS. Gender and age group-wise inequality in health burden and value of premature death from COVID-19 in India. AGING AND HEALTH RESEARCH 2023; 3:100151. [PMID: 37361545 PMCID: PMC10284616 DOI: 10.1016/j.ahr.2023.100151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/17/2023] [Accepted: 06/21/2023] [Indexed: 06/28/2023] Open
Abstract
Background Earlier studies have focused on the age-group-wise health burden of COVID-19 while few studies have focused on the gender-wise analysis of the burden of COVID-19. The present study estimated the health burden and value of premature mortality from COVID-19 based on gender and age. Methods This study was based on secondary data collected from several sources of the government of India. To quantify the health burden, the disability-adjusted life years (DALY) method was used. An abridged life table was used to estimate the fall in life expectancy due to COVID-19. The value of premature mortality was estimated by using the human capital approach. Results Among COVID-19 cases, 65.08% were males and 34.92% were females. The overall health burden caused by COVID-19 was 19,24,107 DALY in 2020, 43,40,526 DALY in 2021, and 8,08,124 DALY in 2022. The health burden per 1000 males was more than double that per 1000 females. This was due to higher rates of infection and case fatality rate among males compared to females. The age group 60-64 years experienced the highest loss of healthy life years per 1000 people, while the age group 55-59 years had the highest overall loss. Due to additional deaths from COVID-19, life expectancy decreased by 0.24 years in 2020, 0.47 years in 2021, and 0.07 years in 2022. The total value of premature death in the first three years of the COVID-19 pandemic amounted to 15,849.99 crores INR. Conclusion In India, males and the older population were more susceptible to the impact of COVID-19.
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Affiliation(s)
- Chandan Kumar Swain
- Department of Analytical & Applied Economics, Utkal University, Bhubaneswar, India
| | - Himanshu Sekhar Rout
- Department of Analytical and Applied Economics &, RUSA Centre of Excellence in Public Policy and Governance, Utkal University, Vani Vihar, Bhubaneswar, Odisha 751 004, India
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Lozano A, Salcedo-Mejía F, Zakzuk J, Alvis-Zakzuk NR, Moyano-Tamara L, Serrano-Coll H, Gastelbondo B, Mattar S, Alvis-Zakzuk NJ, Alvis-Guzman N. Burden of COVID-19 in Córdoba, A Department of Colombia: Results of Disability-Adjusted Life-Years: Carga de COVID-19 en Córdoba, un Departamento de Colombia: Resultados de los Años de Vida Ajustados por Discapacidad. Value Health Reg Issues 2023; 37:9-17. [PMID: 37121135 PMCID: PMC10147312 DOI: 10.1016/j.vhri.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 01/16/2023] [Accepted: 03/20/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVES This study aimed to estimate the burden of acute COVID-19 in Córdoba, one of the most affected departments (states) in Colombia, through the estimation of disability-adjusted life-years (DALYs). METHODS DALYs were estimated based on the number of cases of severe acute respiratory syndrome coronavirus 2 infection cases reported by official Colombian sources. A transition probability matrix among severity states was calculated using data obtained from a retrospective cohort that included 1736 COVID-19 confirmed subjects living in Córdoba. RESULTS Córdoba had 120.23 deaths per 100 000 habitants during the study period (March 2020 to April 2021). Estimated total DALYs were 49 243 (2692 DALYs per 100 000 inhabitants), mostly attributed to fatal cases (99.7%). On average, 25 years of life were lost because of death by this infection. A relevant proportion of years of life lost because of COVID-19 (46.6%) was attributable to people < 60 years old and was greater in men. People ≥ 60 years old showed greater risk of progression to critical state than people between the age of 35 and 60 years (hazard ratio 2.5; 95% confidence interval 2.5-12.5) and younger than 35 years (9.1; 95% confidence interval 4.0-20.6). CONCLUSION In Córdoba, premature mortality because of COVID-19 was substantially represented by people < 60 years old and was greater in males. Our data may be representative of Latin American populations with great infection spread during the first year of the pandemic and contribute to novel methodological aspects and parameter estimations that may be useful to measure COVID-19 burden in other countries of the region.
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Affiliation(s)
- Ana Lozano
- ALZAK Foundation, Cartagena, Colombia; Grupo de Investigación en Economía de la Salud, Universidad de Cartagena, Cartagena, Colombia
| | | | - Josefina Zakzuk
- ALZAK Foundation, Cartagena, Colombia; Grupo de Investigación en Economía de la Salud, Universidad de Cartagena, Cartagena, Colombia
| | | | | | - Héctor Serrano-Coll
- Instituto de Investigaciones Biológicas del Trópico, Universidad de Córdoba, Montería, Córdoba; Facultad de Medicina, Universidad CES, Medellín, Colombia; Instituto Colombiano de Medicina Tropical-Universidad CES, Medellín, Colombia
| | - Bertha Gastelbondo
- Instituto de Investigaciones Biológicas del Trópico, Universidad de Córdoba, Montería, Córdoba
| | - Salim Mattar
- Instituto de Investigaciones Biológicas del Trópico, Universidad de Córdoba, Montería, Córdoba
| | - Nelson J Alvis-Zakzuk
- Departamento de Ciencias de la Salud, Universidad de la Costa, Barranquilla, Colombia; Programa de posgraduación en Epidemiología, Universidad de São Paulo, São Paulo, Brasil.
| | - Nelson Alvis-Guzman
- Grupo de Investigación en Economía de la Salud, Universidad de Cartagena, Cartagena, Colombia; Departamento de Ciencias de la Salud, Universidad de la Costa, Barranquilla, Colombia
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Traebert J, Martins BM, Ferreira PNDSV, Garcia LP, Schuelter-Trevisol F, Traebert E. The burden of disease due to COVID-19 in Florianópolis, Santa Catarina, Brazil, over a one-year period. CIENCIA & SAUDE COLETIVA 2023; 28:1743-1749. [PMID: 37255150 DOI: 10.1590/1413-81232023286.14962022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 10/06/2022] [Indexed: 06/01/2023] Open
Abstract
COVID-19 has had a powerful impact on society with high rates of morbidity and mortality. The use of an epidemiological indicator that estimates the burden of a disease by aggregating early mortality and non-fatal cases in a single measure has the potential to assist in the planning of more appropriate actions at different levels of health care. The scope of this article is to estimate the burden of disease due to COVID-19 in Florianópolis/SC from April 2020 through March 2021. An ecological study was carried out with data from notification and deaths by COVID-19 in the period of 12 months. The burden indicator called Disability-Adjusted Life Years (DALY) was used, obtained by adding the Years of Life Lost (YLL) to the Years of healthy life lost due to disability (YLD). A total of 78,907 confirmed COVID-19 cases were included. Of these, 763 died during the period under study. Overall, 4,496.9 DALYs were estimated, namely a rate of 883.8 DALYs per 100,000 inhabitants. In males, there were 2,693.1 DALYs, a rate of 1,098.0 DALYs per 100,000 males. In women, there were 1,803.8 DALYs, a rate of 684.4 DALYs per100,000 women. The age group most affected in both sexes was 60 to 69 years. The burden of COVID-19 was high in the city studied. The highest rates were in females and in the 60-69 age group.
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Affiliation(s)
- Jefferson Traebert
- Programa de Pós-Graduação em Ciências da Saúde, Universidade do Sul de Santa Catarina. Av. Pedra Branca 25, Cidade Universitária Pedra Branca. 88132-270. Palhoça SC Brasil.
| | | | - Pâmela Nogueira da Silva Vilela Ferreira
- Programa de Pós-Graduação em Ciências da Saúde, Universidade do Sul de Santa Catarina. Av. Pedra Branca 25, Cidade Universitária Pedra Branca. 88132-270. Palhoça SC Brasil.
| | - Leandro Pereira Garcia
- Programa de Pós-Graduação em Ciências da Saúde, Universidade do Sul de Santa Catarina. Av. Pedra Branca 25, Cidade Universitária Pedra Branca. 88132-270. Palhoça SC Brasil.
- Prefeitura de Florianópolis. Florianópolis SC Brasil
| | - Fabiana Schuelter-Trevisol
- Programa de Pós-Graduação em Ciências da Saúde, Universidade do Sul de Santa Catarina. Av. Pedra Branca 25, Cidade Universitária Pedra Branca. 88132-270. Palhoça SC Brasil.
| | - Eliane Traebert
- Programa de Pós-Graduação em Ciências da Saúde, Universidade do Sul de Santa Catarina. Av. Pedra Branca 25, Cidade Universitária Pedra Branca. 88132-270. Palhoça SC Brasil.
- Curso de Medicina. Universidade do Sul de Santa Catarina. Palhoça SC Brasil
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Fu Y, Zhao J, Han P, Zhang J, Wang Q, Wang Q, Wei X, Yang L, Ren T, Zhan S, Li L. Cost-effectiveness of COVID-19 vaccination: A systematic review. J Evid Based Med 2023. [PMID: 37186130 DOI: 10.1111/jebm.12525] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 03/17/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE The COVID-19 vaccination strategy has been widely used to protect population health worldwide. This study aims to summarize the cost-effectiveness evidence of economic evaluation of COVID-19 vaccination strategies to provide evidence supporting the usage of COVID-19 vaccination, especially where the supply of COVID-19 vaccine is limited. METHODS A systematic literature review was performed by searching both English and Chinese databases, including PubMed, Embase, Science Direct, Web of Science, Medline, Scopus, and CNKI. Articles published from January 1, 2020 to August 1, 2022 (PROSPERO registration number: CRD42022355442). RESULTS Of the 1035 papers identified, a total of 28 English studies that met the preset criteria were included. COVID-19 vaccination and booster vaccination were cost-effective or cost-saving regardless of the vaccine type; vaccine efficacy, vaccine price, vaccine supply or prioritization, and vaccination pace were the influential factors of cost-effectiveness among different population groups. When supply is adequate, mass vaccination should be encouraged, while when supply is inadequate, prioritizing the high risk and the elderly is more cost-effective. CONCLUSIONS COVID-19 vaccination strategies are economically favorable in a wide range of countries and population groups, and further research on suitable strategies for booster COVID-19 vaccination is needed.
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Affiliation(s)
- Yaqun Fu
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Jingyu Zhao
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Peien Han
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Jiawei Zhang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Quan Wang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- Brown School, Washington University in St. Louis, St. Louis MO, U.S., St. Louis, United States
| | - Qingbo Wang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Xia Wei
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Li Yang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Tao Ren
- School of Public Health, Peking University, Beijing, China
| | - Siyan Zhan
- Department of Epidemiology and Health Statistics, School of Public Health, Peking University, Beijing, China
| | - Liming Li
- Department of Epidemiology and Health Statistics, School of Public Health, Peking University, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness and Response, Beijing, China
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Tsai HC, Yang YF, Pan PJ, Chen SC. Disease burden due to COVID-19 in Taiwan: disability-adjusted life years (DALYs) with implication of Monte Carlo simulations. J Infect Public Health 2023; 16:884-892. [PMID: 37058869 PMCID: PMC10060021 DOI: 10.1016/j.jiph.2023.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND The novel coronavirus disease 2019 (COVID-19) has affected a large number of countries. Informing the public and decision makers of the COVID-19's economic burdens is essential for understanding the real pandemic impact. METHODS COVID-19 premature mortality and disability impact in Taiwan was analyzed using the Taiwan National Infectious Disease Statistics System (TNIDSS) by estimating the sex/age-specific years of life lost through death (YLLs), the number of years lived with disability (YLDs), and the disability-adjusted life years (DALYs) from January 2020 to November 2021. RESULTS Taiwan recorded 1004.13 DALYs (95% CI: 1002.75-1005.61) per 100,000 population for COVID-19, with YLLs accounting for 99.5% (95% CI: 99.3%99.6%) of all DALYs, with males suffering more from the disease than females. For population aged ≥ 70 years, the disease burdens of YLDs and YLLs were 0.1% and 99.9%, respectively. Furthermore, we found that duration of disease in critical state contributed 63.9% of the variance in DALY estimations. CONCLUSIONS The nationwide estimation of DALYs in Taiwan provides insights into the demographic distributions and key epidemiological parameter for DALYs. The essentiality of enforcing protective precautions when needed is also implicated. The higher YLLs percentage in DALYs also revealed the fact of high confirmed death rates in Taiwan. To reduce infection risks and disease, it is crucial to maintain moderate social distancing, border control, hygiene measures, and increase vaccine coverage levels.
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Oosterhoff M, Kouwenberg LHJA, Rotteveel AH, van Vliet ED, Stadhouders N, de Wit GA, van Giessen A. Estimating the health impact of delayed elective care during the COVID -19 pandemic in the Netherlands. Soc Sci Med 2023; 320:115658. [PMID: 36689820 PMCID: PMC9810553 DOI: 10.1016/j.socscimed.2023.115658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/02/2022] [Accepted: 01/03/2023] [Indexed: 01/05/2023]
Abstract
BACKGROUND The COVID-19 pandemic had a major impact on the continuity of healthcare provision. Appointments, treatments and surgeries for non-COVID patients were often delayed, with associated health losses for patients involved. OBJECTIVE To develop a method to quantify the health impact of delayed elective care for non-COVID patients. METHODS A model was developed that estimated the backlog of surgical procedures in 2020 and 2021 using hospital registry data. Quality-adjusted life years (QALYs) were obtained from the literature to estimate the non-generated QALYs related to the backlog. In sensitivity analyses QALY values were varied by type of patient prioritization. Scenario analyses for future increased surgical capacity were performed. RESULTS In 2020 and 2021 an estimated total of 305,374 elective surgeries were delayed. These delays corresponded with 319,483 non-generated QALYs. In sensitivity analyses where QALYs varied by type of patient prioritization, non-generated QALYs amounted to 150,973 and 488,195 QALYs respectively. In scenario analyses for future increased surgical capacity in 2022-2026, the non-generated QALYs decreased to 311,220 (2% future capacity increase per year) and 300,710 (5% future capacity increase per year). Large differences exist in the extent to which different treatments contributed to the total health losses. CONCLUSIONS The method sheds light on the indirect harm related to the COVID-19 pandemic. The results can be used for policy evaluations of COVID-19 responses, in preparations for future waves or other pandemics and in prioritizing the allocation of resources for capacity increases.
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Affiliation(s)
- Marije Oosterhoff
- Centre for Nutrition, Prevention and Healthcare, National Institute of Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, the Netherlands.
| | - Lisanne H J A Kouwenberg
- Centre for Nutrition, Prevention and Healthcare, National Institute of Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, the Netherlands; Amsterdam UMC location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Adriënne H Rotteveel
- Centre for Nutrition, Prevention and Healthcare, National Institute of Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, the Netherlands.
| | - Ella D van Vliet
- Centre for Health Protection, National Institute of Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, the Netherlands.
| | - Niek Stadhouders
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, PO Box 9101m 6500 HB, Nijmegen, the Netherlands.
| | - G Ardine de Wit
- Centre for Nutrition, Prevention and Healthcare, National Institute of Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, the Netherlands; Vrije Universiteit Amsterdam, Faculty of Science, Department of Health Sciences & Amsterdam Public Health Research Institute, De Boelelaan 1085, 1081 HV, Amsterdam, the Netherlands.
| | - Anoukh van Giessen
- Centre for Nutrition, Prevention and Healthcare, National Institute of Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, the Netherlands.
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12
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John D, Narassima MS, Bhattacharya P, Mukherjee N, Banerjee A, Menon J. Model-based estimation of burden of COVID-19 with disability-adjusted life years and value of statistical life in West Bengal, India. BMJ Open 2023; 13:e065729. [PMID: 36690398 PMCID: PMC9871870 DOI: 10.1136/bmjopen-2022-065729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 11/12/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES The COVID-19 pandemic has posed unprecedented challenges to health systems and populations, particularly in India. Comprehensive, population-level studies of the burden of disease could inform planning, preparedness and policy, but are lacking in India. In West Bengal, India, we conducted a detailed analysis of the burden caused by COVID-19 from its onset to 7 January 2022. SETTING Open-access, population-level and administrative data sets for West Bengal were used. PRIMARY AND SECONDARY OUTCOME MEASURES Disability-adjusted life years (DALYs), years of potential productive life lost (YPPLL), cost of productivity lost (CPL: premature mortality and absenteeism), years of potential life lost (YPLL), premature years of potential life lost, working years of potential life lost (WYPLL) and value of statistical life (VSL) were estimated across scenarios (21 for DALY and 3 each for YPLL and VSL) to evaluate the effects of different factors. RESULTS COVID-19 had a higher impact on the elderly population with 90.2% of deaths arising from people aged above 45. In males and females, respectively, DALYs were 190 568.1 and 117 310.0 years, YPPLL of the productive population was 28 714.7 and 16 355.4 years, CPL due to premature mortality was INR3 198 259 615.6 and INR583 397 335.1 and CPL due to morbidity was INR2 505 568 048.4 and INR763 720 886.1. For males and females, YPLL ranged from 189 103.2 to 272 787.5 years and 117 925.5 to 169 712.0 years for lower to higher age limits, and WYPLL was 54 333.9 and 30 942.2 years. VSL (INR million) for the lower, midpoint and upper life expectancies was 883 330.8; 882 936.4; and 880 631.3, respectively. Vaccination was associated with reduced mortality. CONCLUSIONS The losses incurred due to COVID-19 in terms of the computed estimates in West Bengal revealed a disproportionately higher impact on the elderly and males. Analysis of various age-gender subgroups enhances localised and targeted policymaking to minimise the losses for future pandemics.
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Affiliation(s)
- Denny John
- Department of Life and Allied Health Sciences, MS Ramaiah University of Applied Sciences, Bangalore, Karnataka, India
| | - M S Narassima
- Great Lakes Institute of Management, Chennai, Tamil Nadu, India
| | | | | | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK
- Department of Public Health, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
| | - Jaideep Menon
- Department of Public Health, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
- Department of Cardiology, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
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13
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Fu Y, Zhao J, Wei X, Han P, Yang L, Ren T, Zhan S, Li L. Effectiveness and Cost-Effectiveness of Inactivated Vaccine to Address COVID-19 Pandemic in China: Evidence From Randomized Control Trials and Real-World Studies. Front Public Health 2022; 10:917732. [PMID: 35928479 PMCID: PMC9343737 DOI: 10.3389/fpubh.2022.917732] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThis study aimed to determine the efficacy, effectiveness, and cost-effectiveness of inactivated COVID-19 vaccines (CoronaVac and BBIBP-CorV) in China using existing international clinical trials and real-world evidence.MethodsThrough a search of PubMed, Embase, Web of Science, and CNKI, studies investigating the effectiveness of inactivated COVID-19 vaccines were identified, and a meta-analysis was undertaken to synthesize the vaccine efficacy and effectiveness data. Moreover, a decision-analytic model was developed to estimate the cost-effectiveness of inactivated vaccines for combating the COVID-19 pandemic in the Chinese context from a societal perspective. Results of the meta-analysis, along with cost data from official websites and works of literature were used to populate the model. Sensitivity analysis was performed to test the robustness of the model results.ResultsA total of 24 studies were included in the meta-analysis. In comparison to no immunization, the effectiveness of inactivated vaccine against COVID-19 infection, hospitalization, ICU admission and death were 65.18% (95% CI 62.62, 67.75), 79.10% (95% CI 71.69, 86.51), 90.46% (95% CI 89.42, 91.50), and 86.69% (95% CI 85.68, 87.70); and the efficacy against COVID-19 infection and hospitalization were 70.56% (95% CI 57.87, 83.24) and 100% (95% CI 61.72, 100). Inactivated vaccine vaccination prevented more infections, hospitalizations, ICU admissions, and deaths with lower total costs, thus was cost-saving from a societal perspective in China. Base-case analysis results were robust in the one-way sensitivity analysis, and the percentage of ICU admission or death and direct medical cost ranked the top influential factors in our models. In the probabilistic sensitivity analysis, vaccination had a 100% probability of being cost-effective.ConclusionInactivated vaccine is effective in preventing COVID-19 infection, hospitalization, ICU admission and avoiding COVID-19 related death, and COVID-19 vaccination program is cost-saving from societal perspective in China.
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Affiliation(s)
- Yaqun Fu
- School of Public Health, Peking University, Beijing, China
| | - Jingyu Zhao
- School of Public Health, Peking University, Beijing, China
| | - Xia Wei
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Peien Han
- School of Public Health, Peking University, Beijing, China
| | - Li Yang
- School of Public Health, Peking University, Beijing, China
- *Correspondence: Li Yang
| | - Tao Ren
- School of Public Health, Peking University, Beijing, China
| | - Siyan Zhan
- School of Public Health, Peking University, Beijing, China
| | - Liming Li
- School of Public Health, Peking University, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness and Response, Beijing, China
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14
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Angeles MR, Wanni Arachchige Dona S, Nguyen HD, Le LKD, Hensher M. Modelling the potential acute and post-acute burden of COVID-19 under the Australian border re-opening plan. BMC Public Health 2022; 22:757. [PMID: 35421963 PMCID: PMC9009167 DOI: 10.1186/s12889-022-13169-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/28/2022] [Indexed: 12/16/2022] Open
Abstract
Background Concerns have grown that post-acute sequelae of COVID-19 may affect significant numbers of survivors. However, the analyses used to guide policy-making for Australia’s national and state re-opening plans have not incorporated non-acute illness in their modelling. We, therefore, develop a model by which to estimate the potential acute and post-acute COVID-19 burden using disability-adjusted life years (DALYs) associated with the re-opening of Australian borders and the easing of other public health measures, with particular attention to longer-term, post-acute consequences and the potential impact of permanent functional impairment following COVID-19. Methods A model was developed based on the European Burden of Disease Network protocol guideline and consensus model to estimate the burden of COVID-19 using DALYs. Data inputs were based on publicly available sources. COVID-19 infection and different scenarios were drawn from the Doherty Institute’s modelling report to estimate the likely DALY losses under the Australian national re-opening plan. Long COVID prevalence, post-intensive care syndrome (PICS) and potential permanent functional impairment incidences were drawn from the literature. DALYs were calculated for the following health states: the symptomatic phase, Long COVID, PICS and potential permanent functional impairment (e.g., diabetes, Parkinson’s disease, dementia, anxiety disorders, ischemic stroke). Uncertainty and sensitivity analysis were performed to examine the robustness of the results. Results Mortality was responsible for 72-74% of the total base case COVID-19 burden. Long COVID and post-intensive care syndrome accounted for at least 19 and 3% of the total base case DALYs respectively. When included in the analysis, potential permanent impairment could contribute to 51-55% of total DALYs lost. Conclusions The impact of Long COVID and potential long-term post-COVID disabilities could contribute substantially to the COVID-19 burden in Australia’s post-vaccination setting. As vaccination coverage increases, the share of COVID-19 burden driven by longer-term morbidity rises relative to mortality. As Australia re-opens, better estimates of the COVID-19 burden can assist with decision-making on pandemic control measures and planning for the healthcare needs of COVID-19 survivors. Our estimates highlight the importance of valuing the morbidity of post-COVID-19 sequelae, above and beyond simple mortality and case statistics. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13169-x.
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15
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Disability-adjusted life years (DALYs) due to the direct health impact of COVID-19 in India, 2020. Sci Rep 2022; 12:2454. [PMID: 35165362 PMCID: PMC8844028 DOI: 10.1038/s41598-022-06505-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 01/24/2022] [Indexed: 12/23/2022] Open
Abstract
COVID-19 has affected all countries. Its containment represents a unique challenge for India due to a large population (> 1.38 billion) across a wide range of population densities. Assessment of the COVID-19 disease burden is required to put the disease impact into context and support future pandemic policy development. Here, we present the national-level burden of COVID-19 in India in 2020 that accounts for differences across urban and rural regions and across age groups. Input data were collected from official records or published literature. The proportion of excess COVID-19 deaths was estimated using the Institute for Health Metrics and Evaluation, Washington data. Disability-adjusted life years (DALY) due to COVID-19 were estimated in the Indian population in 2020, comprised of years of life lost (YLL) and years lived with disability (YLD). YLL was estimated by multiplying the number of deaths due to COVID-19 by the residual standard life expectancy at the age of death due to the disease. YLD was calculated as a product of the number of incident cases of COVID-19, disease duration and disability weight. Scenario analyses were conducted to account for excess deaths not recorded in the official data and for reported COVID-19 deaths. The direct impact of COVID-19 in 2020 in India was responsible for 14,100,422 (95% uncertainty interval [UI] 14,030,129–14,213,231) DALYs, consisting of 99.2% (95% UI 98.47–99.64%) YLLs and 0.80% (95% UI 0.36–1.53) YLDs. DALYs were higher in urban (56%; 95% UI 56–57%) than rural areas (44%; 95% UI 43.4–43.6) and in men (64%) than women (36%). In absolute terms, the highest DALYs occurred in the 51–60-year-old age group (28%) but the highest DALYs per 100,000 persons were estimated for the 71–80 years old age group (5481; 95% UI 5464–5500 years). There were 4,815,908 (95% UI 4,760,908–4,924,307) DALYs after considering reported COVID-19 deaths only. The DALY estimations have direct and immediate implications not only for public policy in India, but also internationally given that India represents one sixth of the world’s population.
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16
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Taheri Soodejani M, Abedi Gheshlaghi L, Bahrevar V, Hosseini S, Lotfi MH. Burden of severe COVID-19 in center of Iran: results of disability-adjusted life years (DALYs). INTERNATIONAL JOURNAL OF MOLECULAR EPIDEMIOLOGY AND GENETICS 2021; 12:120-125. [PMID: 35126835 PMCID: PMC8784907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 12/06/2021] [Indexed: 06/14/2023]
Abstract
The outbreak of COVID-19 disease is an international public health concern. Therefore, the analysis of information related to mortality and disability due to COVID-19 is considered important, so the present study was designed and conducted with the aim of assessing COVID-19 Disability-Adjusted Life Years (DALYs) in Yazd. In Yazd province, all suspected cases of COVID-19 that would be referred to central hospitals in order to get confirmed through PCR or CT scan test, were recruited to our study. The fatality data of COVID-19 was gathered from the forensic medicine organization. The Disability-Adjusted Life Years (DALYs) combines in one measure years of life lost (YLL), the loss of healthy life due to premature mortality and years of life lived with disability (YLD), the loss of healthy life because of disease and disability. The total burden of COVID-19 was 23,472 years. The number of years lost due to premature death was 23385 and the number of years of life with disability due to COVID-19 was estimated to be 87 years. The disease burden was 12992 years for men and 10480 years for women. The overall incidence of COVID-19 was 1411 per 100,000, of which 1419 in men and 1402 in women per 100,000. The outbreak of COVID-19 pandemic affected a large population and the residents of Yazd Province lost many years of their lives due to this disease.
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Affiliation(s)
- Moslem Taheri Soodejani
- Center for Healthcare Data Modeling, Department of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical SciencesYazd, Iran
| | | | - Vali Bahrevar
- Msc of Health Education & Promotion MSc of Health Education & Promotion, Department of Health Education & Health Promotion, Shahid Sadoughi University of Medical SciencesYazd, Iran
| | - Saeed Hosseini
- Center for Healthcare Data Modeling, Department of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical SciencesYazd, Iran
| | - Mohammad Hassan Lotfi
- Center for Healthcare Data Modeling, Department of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical SciencesYazd, Iran
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Wu Q, Li Q, Lu J. A One Health strategy for emerging infectious diseases based on the COVID-19 outbreak. JOURNAL OF BIOSAFETY AND BIOSECURITY 2021; 4:5-11. [PMID: 34729464 PMCID: PMC8552662 DOI: 10.1016/j.jobb.2021.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 09/26/2021] [Indexed: 11/13/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is as an emerging infectious disease (EID) that has caused the worst public health catastrophe of the 21st century thus far. In terms of impact, the COVID-19 pandemic is second only to the Spanish Flu pandemic of 1918 in modern world history. As of 7 September 2021, there have been 220 million confirmed cases of COVID-19 and more than 4.5 million deaths. EIDs pose serious public health and socio-economic risks, and 70% of EIDs originate from wildlife. Preventing development of EIDs such as COVID-19 is a pressing concern. Here, taking the COVID-19 pandemic as an example, we illustrate the disastrous effects of EIDs and assess their emergence and evolution from a One Health perspective. We propose a One Health strategy, centered on ‘moving the gates forward’, for EID prevention and control at the human–animal–environment interface. This strategy may be instructive and provide early warnings of EIDs in the future.
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Affiliation(s)
- Qin Wu
- School of Public Health, Sun Yat-sen University, Guangzhou, China.,Key Laboratory for Tropical Disease Control, Sun Yat-sen University, Ministry of Education, Guangzhou, China.,One Health Center of Excellence for Research and Training, Guangzhou, China.,State Key Laboratory for Surveillance and Evaluation of Vaccines and Biological Products, Guangzhou, China
| | - Qianlin Li
- School of Public Health, Sun Yat-sen University, Guangzhou, China.,Key Laboratory for Tropical Disease Control, Sun Yat-sen University, Ministry of Education, Guangzhou, China.,One Health Center of Excellence for Research and Training, Guangzhou, China.,State Key Laboratory for Surveillance and Evaluation of Vaccines and Biological Products, Guangzhou, China
| | - Jiahai Lu
- School of Public Health, Sun Yat-sen University, Guangzhou, China.,Key Laboratory for Tropical Disease Control, Sun Yat-sen University, Ministry of Education, Guangzhou, China.,One Health Center of Excellence for Research and Training, Guangzhou, China.,State Key Laboratory for Surveillance and Evaluation of Vaccines and Biological Products, Guangzhou, China
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