关于大型体育比赛 COVID-19 监测策略的成本效益分析。
Cost-effectiveness analysis on COVID-19 surveillance strategy of large-scale sports competition.
机构信息
School of Public Health, Peking University, Beijing, 100191, China.
School of Mathematical Sciences, Peking University, Beijing, 100871, China.
出版信息
Infect Dis Poverty. 2022 Mar 18;11(1):32. doi: 10.1186/s40249-022-00955-3.
BACKGROUND
Nucleic acid test (NAT) could effectively control the spread of COVID-19 caused by large-scale sports competitions. However, quantitative analysis on the appropriate frequency of NAT is scarce, and the cost-effectiveness and necessity of high-frequency NAT remain to be fully explored and validated. This study aims to optimize the COVID-19 surveillance strategies through cost-effectiveness analysis for the Tokyo 2020 Olympic Games and the upcoming Beijing 2022 Olympic Winter Games.
METHODS
A total of 18 scenarios were designed regarding the NAT frequency, symptom monitoring, and strengthening close-contact control. An agent-based stochastic dynamic model was used to compare the cost-effectiveness of different NAT scenarios and optimize the surveillance strategies. The dynamics of the proposed model included the arrival and departure of agents, transmission of the disease according to Poisson processes, and quarantine of agents based on regular NATs and symptom onset. Accumulative infections, cost, and incremental cost-effectiveness ratio (ICER) were simulated in the frame of the model. ICER was used to compare the cost-effectiveness of different scenarios. Univariate sensitivity analysis was performed to test the robustness of the results.
RESULTS
In Scenario 16, where the competition-related personnel (CRP) received NAT daily and national sports delegation (NSD) with quarantined infections accepted an additional NAT daily, accumulative infection was 320.90 (90 initial infections), the total cost was (United States Dollar) USD 8 920 000, and the cost of detecting out each infection was USD 27 800. Scenario 16 would reduce the total cost by USD 22 570 000 (avoid 569.61 infections), USD 1 420 000 (avoid 47.2 infections) compared with Scenario 10 (weekly NAT, strengthened close contact control) and Scenario 7 (daily NAT, no strengthened close contact control), respectively. Sensitivity analysis showed that the result was most sensitive to the change in basic reproductive number.
CONCLUSIONS
High-frequency NATs such as bidaily, daily, and twice a day were cost-effective. NAT daily for CRP with strengthening close-contact control could be prioritized in defense against COVID-19 at large-scale sports competitions. This study could assist policymakers by assessing the cost-effectiveness of NAT scenarios and provide the host country with an optimal COVID-19 surveillance strategy.
背景
核酸检测（NAT）可有效控制大型体育赛事引发的 COVID-19 传播。然而，关于适当 NAT 频率的定量分析较少，高频 NAT 的成本效益和必要性仍有待充分探索和验证。本研究旨在通过成本效益分析，为 2020 年东京奥运会和即将到来的 2022 年北京冬奥会优化 COVID-19 监测策略。
方法
共设计了 18 种 NAT 频率、症状监测和强化密切接触控制方案。采用基于代理的随机动态模型比较不同 NAT 方案的成本效益，优化监测策略。模型中的动态包括代理的到达和离开、按泊松过程传播疾病以及基于定期 NAT 和症状发作对代理进行隔离。在模型框架内模拟累积感染、成本和增量成本效益比（ICER）。使用 ICER 比较不同方案的成本效益。进行单变量敏感性分析以测试结果的稳健性。
结果
在方案 16 中，竞赛相关人员（CRP）每天接受 NAT，有隔离感染的国家体育代表团（NSD）每天额外接受一次 NAT，累积感染为 320.90（90 初始感染），总费用为 892 万美元，检测每个感染的成本为 27800 美元。与方案 10（每周 NAT，强化密切接触控制）和方案 7（每日 NAT，无强化密切接触控制）相比，方案 16 将分别减少总费用 2257 万美元（避免 569.61 例感染）和 142 万美元（避免 47.2 例感染）。敏感性分析表明，结果对基本繁殖数的变化最为敏感。
结论
高频 NAT，如每日两次、每日和每日，具有成本效益。对于 CRP，强化密切接触控制的高频 NAT 可以优先用于大型体育赛事的 COVID-19 防御。本研究可以通过评估 NAT 方案的成本效益为政策制定者提供帮助，并为主办国提供最佳的 COVID-19 监测策略。
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