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

  1. Constantine Vardavas
  2. Konstantinos Zisis
  3. Katerina Nikitara
  4. Ioanna Lagou
  5. Katerina Aslanoglou
  6. Kostas Athanasakis
  7. Revati Phalkey
  8. Jo Leonardi-Bee
  9. Esteve Fernandez
  10. Orla Condell
  11. Favelle Lamb
  12. Frank Sandmann
  13. Anastasia Pharris
  14. Charlotte Deogan
  15. Jonathan E. Suk

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Abstract

Objectives

COVID-19 poses a threat of loss of life, economic instability, and social disruption. We conducted a systematic review of published economic analyses to assess the direct and indirect costs of the SARS-CoV-2 pandemic, and to contrast these with the costs and the cost-benefit of public health surveillance, preparedness, and response measures in averting and/or responding to SARS-CoV-2 pandemic.

Setting

A systematic literature review was conducted to identify peer-reviewed articles estimating the cost of the COVID-19 pandemic and the cost-effectiveness of pharmaceutical or non-pharmaceutical interventions in EU/EEA/UK and OECD countries, published from the 1st of January 2020 through 22nd April 2021 in Ovid Medline and EMBASE. The cost-effectiveness of interventions was assessed through a dominance ranking matrix approach. All cost data were adjusted to the 2021 Euro, with interventions compared with the null.

Primary and secondary outcome measures

Direct and indirect costs for SARS-CoV-2 and preparedness and/or response or cost-benefit and cost-effectiveness were measured.

Results

We included data from 41 economic studies. Ten studies evaluated the cost of COVID-19 pandemic, while 31 assessed the cost-benefit of public health surveillance, preparedness, and response measures. Overall, the economic burden of SARS-CoV-2 was found to be substantial for both the general population and within specific population subgroups. Community screening, bed provision policies, investing in personal protective equipment and vaccination strategies were cost-effective, in most cases due to the representative economic value of below acceptable cost-effectiveness thresholds. Physical distancing measures were associated with health benefits; however, their cost-effectiveness was dependent on the duration, compliance and the phase of the epidemic in which it was implemented.

Conclusions

SARS-CoV-2 is associated with substantial economic costs to healthcare systems, payers, and societies, both short term and long term, while interventions including testing and screening policies, vaccination and physical distancing policies were identified as those presenting cost-effective options to deal with the pandemic, dependent on population vaccination and the Re at the stage of the pandemic.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2022.05.31.22275813: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    RandomizationInitially, a random sample of 100 titles and abstracts were screened independently for eligibility by two reviewers to enable consistency in screening and identify areas for amendments in the inclusion criteria.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Search strategy and selection criteria: A systematic review was conducted to identify peer-reviewed articles published from the 1st January 2020 through 22nd April 2021 in Ovid Medline and EMBASE.
    EMBASE
    suggested: (EMBASE, RRID:SCR_001650)
    Comparative economic analysis approach: All cost data were adjusted to a common currency (Euro in 2021) and price year, using the Campbell and Cochrane Economics Methods Group–Evidence for Policy and Practice Information and Coordinating Centre cost converter (13).
    Cochrane Economics
    suggested: None

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and limitations: This review provides several strengths, including covering within one review both the economic burden of COVID-19 and the cost-effectiveness of the strategies and programs implemented to mitigate the pandemic. Moreover, this review followed a systematic approach to study identification, data extraction and quality apprasial with most of the included studies of good or high quality. Furthermore, this study used the Dominance Ranking Matrix approach, which summarised and interpreted the results of economic evaluation studies. On the other hand there are some limitations, as publication bias can not be excluded and as our search was performed up to the end of April 2021 it only reflects the cost-effectiveness of interventions assessed during the first waves of the pandemic with the majority of the populations unvaccinated, while most studies have a short duration on which modelling was performed. A further limitation is that most studies estimate costs and benefits based on a health care perspective, excluding wider societal effects, with a time horizon of 1 year. As we restricted our search to EU/UK/EEA/US and OECD countries, the studies primarily refer to high-income countries. Finally, as costs and resources varied between different countries, different pandemic settings and over time, and as indicated in this review, dependent on multiple other factors including population vaccination status, preexisting healthcare capacity and the infectivity of t...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2022.05.31.22275813v1 on medRxiv