Reddy Krishna P, Shebl Fatma M, Foote Julia H A, Harling Guy, Scott Justine A, Panella Christopher, Fitzmaurice Kieran P, Flanagan Clare, Hyle Emily P, Neilan Anne M, Mohareb Amir M, Bekker Linda-Gail, Lessells Richard J, Ciaranello Andrea L, Wood Robin, Losina Elena, Freedberg Kenneth A, Kazemian Pooyan, Siedner Mark J
Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.
Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA.
medRxiv. 2020 Oct 11:2020.06.29.20140111. doi: 10.1101/2020.06.29.20140111.
Healthcare resource constraints in low and middle-income countries necessitate selection of cost-effective public health interventions to address COVID-19.
We developed a dynamic COVID-19 microsimulation model to evaluate clinical and economic outcomes and cost-effectiveness of epidemic control strategies in KwaZulu-Natal, South Africa. Interventions assessed were Healthcare Testing (HT), where diagnostic testing is performed only for those presenting to healthcare centres; Contact Tracing (CT) in households of cases; Isolation Centres (IC), for cases not requiring hospitalisation; community health worker-led Mass Symptom Screening and molecular testing for symptomatic individuals (MS); and Quarantine Centres (QC), for household contacts who test negative. Given uncertainties about epidemic dynamics in South Africa, we evaluated two main epidemic scenarios over 360 days, with effective reproduction numbers (R) of 1·5 and 1·2. We compared , +, ++, +++, +++, and ++++, considering strategies with incremental cost-effectiveness ratio (ICER) <US$3,250/year-of-life saved (YLS) cost-effective. In sensitivity analyses, we varied R, molecular testing sensitivity, and efficacies and costs of interventions.
With R 1·5, resulted in the most COVID-19 deaths over 360 days. Compared with , ++++ reduced mortality by 94%, increased costs by 33%, and was cost-effective (ICER $340/YLS). In settings where quarantine centres cannot be implemented, +++ was cost-effective compared with (ICER $590/YLS). With R 1·2, +++ was the least costly strategy, and no other strategy was cost-effective. ++++ was cost-effective in many sensitivity analyses; notable exceptions were when R was 2·6 and when efficacies of ICs and QCs for transmission reduction were reduced.
In South Africa, strategies involving household contact tracing, isolation, mass symptom screening, and quarantining household contacts who test negative would substantially reduce COVID-19 mortality and be cost-effective. The optimal combination of interventions depends on epidemic growth characteristics and practical implementation considerations.
低收入和中等收入国家的医疗资源限制使得有必要选择具有成本效益的公共卫生干预措施来应对新冠疫情。
我们开发了一个动态新冠疫情微观模拟模型，以评估南非夸祖鲁-纳塔尔省疫情控制策略的临床和经济结果以及成本效益。评估的干预措施包括医疗检测（HT），即仅对前往医疗中心的人员进行诊断检测；对病例家庭进行接触者追踪（CT）；为不需要住院的病例设立隔离中心（IC）；由社区卫生工作者主导对有症状个体进行大规模症状筛查和分子检测（MS）；以及为检测呈阴性的家庭接触者设立检疫中心（QC）。鉴于南非疫情动态的不确定性，我们在360天内评估了两种主要疫情情景，有效繁殖数（R）分别为1.5和1.2。我们比较了 ，+，++，+++，+++和++++，认为增量成本效益比（ICER）<3250美元/挽救生命年（YLS）的策略具有成本效益。在敏感性分析中，我们改变了R、分子检测敏感性以及干预措施的效果和成本。
当R为1.5时， 在360天内导致的新冠死亡人数最多。与 相比，++++将死亡率降低了94%，成本增加了33%，且具有成本效益（ICER为340美元/YLS）。在无法设立检疫中心的情况下，与 相比，+++具有成本效益（ICER为590美元/YLS）。当R为1.2时，+++是成本最低的策略，没有其他策略具有成本效益。在许多敏感性分析中，++++具有成本效益；显著的例外情况是当R为2.6时，以及当IC和QC减少传播的效果降低时。
在南非，涉及家庭接触者追踪、隔离、大规模症状筛查以及对检测呈阴性的家庭接触者进行检疫的策略将大幅降低新冠死亡率且具有成本效益。干预措施的最佳组合取决于疫情增长特征和实际实施考虑因素。
