Disability-Adjusted Life-Years for Drug Overdose Crisis and COVID-19 Are Comparable During the Two Years of Pandemic in the United States

ObjectivesThe drug overdose crisis with shifting patterns from primarily opioid to polysubstance uses and COVID-19 infections are 2 concurrent public health crises in the United States, affecting the population of sizes in different magnitudes (approximately < 10 million for substance use disorder [SUD] and drug overdoses vs 80 million for COVID-19 within 2 years of the pandemic). Our objective is to compare the relative scale of disease burden for the 2 crises within a common framework, which could help inform policy makers with resource allocation and prioritization strategies.MethodsWe calculated disability-adjusted life-years (DALYs) for SUD (including opioids and stimulants) and COVID-19 infections, respectively. We collected estimates for SUD prevalence, overdose deaths, COVID-19 cases and deaths, disability weights, and life expectancy from multiple publicly available sources. We then compared age distributions of estimated DALYs.ResultsWe estimated a total burden of 13.83 million DALYs for SUD and drug overdoses and 15.03 million DALYs for COVID-19 in 2 years since March 2020. COVID-19 burden was dominated by the fatal burden (> 95% of total DALYs), whereas SUD burden was attributed to both fatal (53%) and nonfatal burdens (47%). The highest disease burden was among individuals aged 30 to 39 years for SUD (27%) and 50 to 64 years for COVID-19 (31%).ConclusionsDespite the smaller size of the affected population, SUD and drug overdoses resulted in comparable disease burden with the COVID-19 pandemic. Additional resources supporting evidence-based interventions in prevention and treatment may be warranted to ameliorate SUD and drug overdoses during both the pandemic and postpandemic recovery.     

The Impact of Funding Inpatient Treatments for COVID-19 on Health Equity in the United States: A Distributional Cost-Effectiveness Analysis

ObjectivesWe conducted a distributional cost-effectiveness analysis (DCEA) to evaluate how Medicare funding of inpatient COVID-19 treatments affected health equity in the United States.MethodsA DCEA, based on an existing cost-effectiveness analysis model, was conducted from the perspective of a single US payer, Medicare. The US population was divided based on race and ethnicity (Hispanic, non-Hispanic black, and non-Hispanic white) and county-level social vulnerability index (5 quintile groups) into 15 equity-relevant subgroups. The baseline distribution of quality-adjusted life expectancy was estimated across the equity subgroups. Opportunity costs were estimated by converting total spend on COVID-19 inpatient treatments into health losses, expressed as quality-adjusted life-years (QALYs), using base-case assumptions of an opportunity cost threshold of $150 000 per QALY gained and an equal distribution of opportunity costs across equity-relevant subgroups.ResultsMore socially vulnerable populations received larger per capita health benefits due to higher COVID-19 incidence and baseline in-hospital mortality. The total direct medical cost of inpatient COVID-19 interventions in the United States in 2020 was estimated at $25.83 billion with an estimated net benefit of 735 569 QALYs after adjusting for opportunity costs. Funding inpatient COVID-19 treatment reduced the population-level burden of health inequality by 0.234%. Conclusions remained robust across scenario and sensitivity analyses.ConclusionsTo the best of our knowledge, this is the first DCEA to quantify the equity implications of funding COVID-19 treatments in the United States. Medicare funding of COVID-19 treatments in the United States could improve overall health while reducing existing health inequalities.     

Assessing the cost-effectiveness of COVID-19 vaccines in a low incidence and low mortality setting: the case of Thailand at start of the pandemic

Objective

This study aimed to assess the cost-effectiveness of COVID-19 vaccines, preferred COVID-19 vaccine profiles, and the preferred vaccination strategies in Thailand.

Methods

An age-structured transmission dynamic model was developed based on key local data to evaluate economic consequences, including cost and health outcome in terms of life-years (LYs) saved. We considered COVID-19 vaccines with different profiles and different vaccination strategies such as vaccinating elderly age groups (over 65s) or high-incidence groups, i.e. adults between 20 and 39 years old who have contributed to more than 60% of total COVID-19 cases in the country thus far. Analyses employed a societal perspective in a 1-year time horizon using a cost-effectiveness threshold of 160,000 THB per LY saved. Deterministic and probabilistic sensitivity analyses were performed to identify and characterize uncertainty in the model.

Results

COVID-19 vaccines that block infection combined with social distancing were cost-saving regardless of the target population compared to social distancing alone (with no vaccination). For vaccines that block infection, the preferred (cost-effective) strategy was to vaccinate the high incidence group. Meanwhile, COVID-19 vaccines that reduces severity (including hospitalization and mortality) were cost-effective when the elderly were vaccinated, while vaccinating the high-incidence group was not cost-effective with this vaccine type. Regardless of vaccine type, higher vaccination coverage, higher efficacy, and longer protection duration were always preferred. More so, vaccination with social distancing measures was always preferred to strategies without social distancing. Quarantine-related costs were a major cost component affecting the cost-effectiveness of COVID-19 vaccines.

Conclusion

COVID-19 vaccines are good value for money even in a relatively low-incidence and low-mortality setting such as Thailand, if the appropriate groups are vaccinated. The preferred vaccination strategies depend on the type of vaccine efficacy. Social distancing measures should accompany a vaccination strategy.

     

Cost-Effectiveness of Interventions for Reducing Road Traffic Injuries Related to Driving under the Influence of Alcohol

ObjectiveTo determine the cost-effectiveness of interventions to reduce road traffic injuries caused by driving under the influence of alcohol in Thailand.MethodsWe used generalized cost-effectiveness analysis and included costs from a health sector perspective. The model considered road traffic crash victims who were injured, disabled, or died. We obtained proportions of alcohol-related crashes from the Thai Injury Surveillance system. Intervention effectiveness was derived from published reviews and a study in one province of Thailand. Random breath testing, selective breath testing, and mass media campaigns, both current and intervention scenarios, were compared with a “do-nothing” scenario. We calculated intervention costs and cost offsets of prevented treatment costs in 2004 Thai baht (US $1 = 41 baht) and measured benefits in terms of disability-adjusted life-years averted. Interventions with incremental cost-effectiveness ratios below 110,000 Thai baht (1×gross domestic product per capita) per disability-adjusted life-year (US $2,680) were considered very cost-effective.ResultsCompared with doing nothing, mass media campaigns, random breath testing, and selective breath testing are all cost saving. When averted treatment costs are ignored and only intervention costs are included, all three interventions are very cost-effective, with incremental cost-effectiveness ratios of 10,300, 14,300 and 13,000 baht/disability-adjusted life-year, respectively. The current mix of mass media campaigns and sobriety checkpoints is therefore also cost-effective, but underinvestment in checkpoints limits its overall effect.ConclusionsA greater intensity of conducting sobriety checkpoints in Thailand is recommended to complement the investment in mass media campaigns. Together these interventions have the potential to reduce the burden of alcohol-related road traffic injuries by 24%.     

Pharmaceutical Portfolio Management: Global Disease Burden and Corporate Performance Metrics

BackgroundBiopharmaceutical companies face multiple external pressures. Shareholders demand a profitable company while governments, nongovernmental third parties, and the public at large expect a commitment to improving health in developed and, in particular, emerging economies. Current industry commercial models are inadequate for assessing opportunities in emerging economies where disease and market data are highly limited.ObjectiveThe purpose of this article was to define a conceptual framework and build an analytic decision-making tool to assess and enhance a company’s global portfolio while balancing its business needs with broader social expectations.MethodsThrough a case-study methodology, we explore the relationship between business and social parameters associated with pharmaceutical innovation in three distinct disease areas. The global burden of disease–based theoretical framework using disability-adjusted life-years provides an overview of the burden associated with particular diseases. The social return on investment is expressed as disability-adjusted life-years averted as a result of the particular pharmaceutical innovation. Simultaneously, the business return on investment captures the research and development costs and projects revenues in terms of a profitability index.ConclusionsThe proposed framework can assist companies as they strive to meet the medical needs of populations around the world for decades to come.     

Economic burden of COVID-19, China,January–March, 2020: a cost-of-illness study

ObjectiveTo estimate the economic cost of coronavirus disease 19 (COVID-19) in 31 provincial-level administrative regions and in total, in China.MethodsWe used data from government reports, clinical guidelines and other publications to estimate the main cost components of COVID-19 during 1 January–31 March 2020. These components were: identification and diagnosis of close contacts; suspected cases and confirmed cases of COVID-19; treatment of COVID-19 cases; compulsory quarantine of close contacts and suspected cases; and productivity losses for all affected residents. Primary outcomes were total health-care and societal costs.FindingsThe total estimated health-care and societal costs associated with COVID-19 were 4.26 billion Chinese yuan (¥; 0.62 billion United States dollars, US$) and ¥ 2646.70 billion (US$ 383.02 billion), respectively. Inpatient care accounted for 44.2% (¥ 0.95 billion/¥ 2.15 billion) of routine health-care costs followed by medicines, accounting for 32.5% (¥ 0.70 billion/¥ 2.15 billion). Productivity losses accounted for 99.8% (¥ 2641.61 billion/¥ 2646.70 billion) of societal costs, which were mostly attributable to the effect of movement-restriction policies on people who did not have COVID-19. Societal costs were most sensitive to salary costs and number of working days lost due to movement-restriction policies. Hubei province had the highest health-care cost while Guangdong province had the highest societal cost.ConclusionOur results highlight the high economic burden of the COVID-19 outbreak in China. The control measures to prevent the spread of disease resulted in substantial costs from productivity losses amounting to 2.7% (US$ 382.29 billion/US$ 14.14 trillion) of China’s annual gross domestic product.     

Global,regional and national burden of disease attributable to 19 selected occupational risk factors for 183 countries, 2000–2016: A systematic analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury

ObjectivesWe provide a brief introduction to the objectives, data, methods and results of the World Health Organization (WHO)/International Labor Organization (ILO) Joint Estimates of the Work-related Burden of Disease and Injury (WHO/ILO Joint Estimates), which estimated the burden attributable to 19 selected occupational risk factors.MethodsThe WHO/ILO Joint Estimates were produced within the global Comparative Risk Assessment framework, which attributes the burden of one specific health outcome (ie, disease/injury) to a specific occupational risk factor. For 39 established occupational risk factor-health outcome pairs, estimates are produced using population attributable fractions (PAF) from recent burden of disease estimates. For two additional pairs, PAF are calculated from new databases of exposure and risk ratios produced in WHO/ILO systematic reviews. Attributable disease burdens were estimated by applying the PAF to total disease burdens.ResultsGlobally in 2016, it is estimated that 1.88 [95% uncertainty range (UR) 1.84–1.92] million deaths and 89.72 (95% UR 88.61–90.83) million disability-adjusted life years were attributable to the 19 selected occupational risk factors and their health outcomes. A disproportionately large work-related burden of disease is observed in the WHO African Region (for disability-adjusted life years), South-East Asia Region, and Western Pacific Region (for deaths), males and older age groups.ConclusionsThe WHO/ILO Joint Estimates can be used for global monitoring of exposure to occupational risk factors and work-related burden of disease and to identify, plan, cost, implement and evaluate policies, programs and actions to prevent exposure to occupational risk factors and their associated burden.     

A Cost-Utility Analysis of Remote Pulse-Oximetry Monitoring of Patients With COVID-19

ObjectivesSince 2020, COVID-19 has infected tens of millions and caused hundreds of thousands of fatalities in the United States. Infection waves lead to increased emergency department utilization and critical care admission for patients with respiratory distress. Although many individuals develop symptoms necessitating a ventilator, some patients with COVID-19 can remain at home to mitigate hospital overcrowding. Remote pulse-oximetry (pulse-ox) monitoring of moderately ill patients with COVID-19 can be used to monitor symptom escalation and trigger hospital visits, as needed.MethodsWe analyzed the cost-utility of remote pulse-ox monitoring using a Markov model with a 3-week time horizon and daily cycles from a US health sector perspective. Costs (US dollar 2020) and outcomes were derived from the University Hospitals’ real-world evidence and published literature. Costs and quality-adjusted life-years (QALYs) were used to determine the incremental cost-effectiveness ratio at a cost-effectiveness threshold of $100 000 per QALY. We assessed model uncertainty using univariate and probabilistic sensitivity analyses.ResultsModel results demonstrated that remote monitoring dominates current standard care, by reducing costs ($11 472 saved) and improving outcomes (0.013 QALYs gained). There were 87% fewer hospitalizations and 77% fewer deaths among patients with access to remote pulse-ox monitoring. The incremental cost-effectiveness ratio was not sensitive to uncertainty ranges in the model.ConclusionsPatient with COVID-19 remote pulse-ox monitoring increases the specificity of those requiring follow-up care for escalating symptoms. We recommend remote monitoring adoption across health systems to economically manage COVID-19 volume surges, maintain patients’ comfort, reduce community infection spread, and carefully monitor needs of multiple individuals from one location by trained experts.     

Rapid response to crisis: Health system lessons from the active period of COVID-19

BackgroundThis paper outlines the need for a health systems approach and rapid response strategy for gathering information necessary for policy decisions during pandemics and similar crises. It suggests a new framework for assessing the phases of the pandemic.MethodThe paper draws its information and conclusions from a rapid synthesis and translation process (RSTP) of a series of webinars and online discussions from the Pandemic-Mental Health International Network (Pan-MHIN) - policy experts from across 16 locations in Australia, Denmark, Italy, Spain, Taiwan, the UK and the USA. While the initial focus of this research was on mental health, COVID-19 has raised much broader issues and questions for health planners.ResultsWe identified gaps affecting the capacity to respond effectively and quickly, including in relation to system indicators, the inadequacy of the prior classification of the phases of the pandemic, the absences of a healthcare ecosystem approach, and the quick shift to digital technologies. The strengths and weaknesses of COVID-19 responses across different systems, services, sites and countries been identified and compared, including both low and high impacted areas.ConclusionsThere is an urgent need for managerial epidemiology based on healthcare ecosystem research encompassing multidisciplinary teams, visualization tools and decision analytics for rapid response. Policy and healthcare context played a key role in the response to COVID-19. Its severity, the containment measures and the societal response varied greatly across sites and countries. Understanding this variation is vital to assess the impact of COVID-19 in specific areas such as ageing or mental health.     

重庆市2010-2013年人群疾病负担研究

目的 分析重庆市人群所患疾病的健康损失和经济损失负担,为制定疾病防控策略提供可靠的科学依据。方法 采用伤残调整生命年(DALY)测量重庆市2010-2013年人群疾病的健康损失,以二步模型法计算直接经济负担,将DALY与人力资本法结合测算疾病的间接经济负担。结果 2010-2013年重庆市DALY(/1 000人)损失分别为123.90、127.01、123.30和125.99。其中疾病负担模式以非传染性疾病为主(83%~87%),其次为损伤,最低的为传染性疾病。2010-2013年前五位疾病分类均为呼吸系统疾病、循环系统疾病、恶性肿瘤、意外伤害、精神神经疾病。2013年重庆市疾病总经济负担为1 621.34亿元,其中直接经济负担和间接经济负担分别为794.42亿元和826.92亿元,主要负担在循环系统疾病、呼吸系统疾病、损伤、恶性肿瘤和肌肉骨骼和结缔组织疾病等疾病。结论 呼吸系统疾病、循环系统疾病、恶性肿瘤、损伤给重庆市居民带来了严重的健康和经济损失负担,应重点加强这些疾病的预防和控制。     

A model for the incremental burden of invasive Haemophilus influenzae type b due to a decline of childhood vaccination during the COVID-19 outbreak: A dynamic transmission model in Japan

BackgroundThe current coronavirus disease 2019 (COVID-19) outbreak has caused a persistent decline in childhood vaccination coverage, including Haemophilus influenzae type b (Hib) vaccine, in some countries. Our objective was to evaluate the impact of decreased Hib vaccination due to COVID-19 on invasive Hib disease burden in Japan.MethodsUsing a deterministic dynamic transmission model (susceptible-carriage-infection-recovery model), the incidence rates of invasive Hib disease in under 5 year olds in rapid vaccination recovery and persistent vaccination declined scenarios were compared for the next 10 years after 2020. The national Hib vaccination rate after the impact of COVID-19 reduced to 87% and 73% in 2020 from approximately 97% each in 2013–2019 for primary and booster doses.ResultsWhile the persistent decline scenarios revealed an increase in invasive Hib disease incidence to 0.50/100,000 children under 5 years old, the incidence of the rapid recovery scenario slightly increased with a consistent decline of incidence after 2021. The shorter the duration of the decline in vaccination rate was, the smaller the incremental disease burden observed in the model. Compared to the rapid recovery scenario, the permanent decline scenario showed a 296.87 cumulative incremental quality-adjusted life years (QALY) loss for the next 10 years.ConclusionsThe persistent decline of Hib vaccination rate due to COVID-19 causes an incremental disease burden irrespective of the possible decline of Hib transmission rate by COVID-19 mitigation measures. A rapid recovery of vaccination coverage rate can prevent this possible incremental disease burden.     

Cost-effectiveness of 13-valent pneumococcal conjugate vaccination in Mongolia

ObjectiveThe Ministry of Health (MOH), Mongolia, is considering introducing 13-valent pneumococcal conjugate vaccine (PCV13) in its national immunization programme to prevent the burden of disease caused by Streptococcus pneumoniae. This study evaluates the cost-effectiveness and budget impact of introducing PCV13 compared to no PCV vaccination in Mongolia.MethodsThe incremental cost-effectiveness ratio (ICER) of introducing PCV13 compared to no PCV vaccination was assessed using an age-stratified static multiple cohort model. The risk of various clinical presentations of pneumococcal disease (meningitis, pneumonia, non-meningitis non-pneumonia invasive pneumococcal disease and acute otitis media) at all ages for thirty birth cohorts was assessed. The analysis considered both health system and societal perspectives. A 3 + 0 vaccine schedule and price of US$3.30 per dose was assumed for the baseline scenario based on Gavi, the Vaccine Alliance’s advance market commitment tail price.ResultsThe ICER of PCV13 introduction is estimated at US$52 per disability-adjusted life year (DALY) averted (health system perspective), and cost-saving (societal perspective). Although indirect effects of PCV have been well-documented, a conservative scenario that does not consider indirect effects estimated PCV13 introduction to cost US$79 per DALY averted (health system perspective), and US$19 per DALY averted (societal perspective). Vaccination with PCV13 is expected to cost around US$920,000 in 2016, and thereafter US$820,000 every year. The programme is likely to reduce direct disease-related costs to MOH by US$440,000 in the first year, increasing to US$510,000 by 2025.ConclusionIntroducing PCV13 as part of Mongolia’s national programme appears to be highly cost-effective when compared to no vaccination and cost-saving from a societal perspective at vaccine purchase prices offered through Gavi. Notwithstanding uncertainties around some parameters, cost-effectiveness of PCV introduction for Mongolia remains robust over a range of conservative scenarios. Availability of high-quality national data would improve future economic analyses for vaccine introduction.     

The Cost-Effectiveness of Remdesivir for Hospitalized Patients With COVID-19

ObjectivesThis study aimed to estimate the cost-effectiveness of remdesivir, the first novel therapeutic to receive Emergency Use Authorization for the treatment of hospitalized patients with COVID-19, and identify key drivers of value to guide future pricing and reimbursement efforts.MethodsA Markov model evaluated the cost-effectiveness of remdesivir in patients hospitalized with COVID-19 from a US healthcare sector perspective. A lifetime time horizon captured potential long-term costs and outcomes. Model outcomes included discounted total costs, life-years, and quality-adjusted life-years (QALYs). Remdesivir was modeled as an addition to standard of care and compared with standard of care alone, including dexamethasone for patients requiring respiratory support. COVID-19 hospitalizations were assumed to be reimbursed through a single payment based on the respiratory support received alongside a remdesivir carveout payment in the base case. Sensitivity and scenario analyses identified key drivers.ResultsAt a unit price of $520 per vial and assuming no survival benefit with remdesivir, the incremental cost-effectiveness was $298 200/QALY for patients with moderate to severe COVID-19 and $1 847 000/QALY for patients with mild COVID-19. Although current data do not support a survival benefit, if one was assumed, the cost-effectiveness estimate was $50 100/QALY for the moderate to severe population and $103 400/QALY for the mild population. Another key driver included the hospitalization payment structure (per diem vs bundled payment).ConclusionsWith the current evidence available, remdesivir’s price is too high to align with its expected health gains for hospitalized patients with COVID-19. Results from this study provide a rationale for iterative health technology assessment.     

乙型肝炎母婴阻断策略成本效果可支付性分析

目的 分析我国乙型肝炎（乙肝）母婴阻断策略的成本效果价值,探索支付意愿和预算规模对项目持续投入的影响。方法 以乙肝母婴阻断为研究策略,不接种为对照策略,采用决策分析马尔科夫模型,以我国2013年出生人口数为队列人群,通过TreeAge Pro 2015软件实现模拟运行。分别从全社会和支付者角度计算成本,效果包括乙肝相关疾病人数和质量调整生命年（QALYs）,策略间比较采用增量成本效果比（ICER）。由敏感性分析明确各参数的不确定性,绘制成本效果可支付曲线评价策略的可支付性。结果 接受乙肝母婴阻断后终其一生所承担的成本为4 063.5元/人,比不接种节省37 829.7元/人。人均获得QALYs为24.516 1,与不接种策略相比增加明显,且可以减少乙肝相关疾病的发生。从全社会角度看,乙肝母婴阻断与不接种相比,每多获得一个QALYs分别可节省59 136.6元,根据本研究成本效果阈值,说明乙肝母婴阻断具有成本效果价值。一维、多维和概率敏感性分析显示,上述结果稳定可靠。成本效果可接受曲线显示,结果不会因公众支付意愿变化而影响,且研究策略完全实现的支付意愿小于成本效果阈值。可支付分析显示,我国实施该策略的年预算在5.904亿~6.888亿元,不会超出财政支付能力;同一支付意愿下,年预算越高本研究策略具有经济性及可支付性的概率越高,只有当年预算达到6.888亿元,该策略才能完全实现。结论 我国推行的乙肝母婴阻断策略具有成本效果价值,并未超出公众支付意愿和财政预算能力,顺应了全球消除乙肝的目标要求,值得大力实施和推广。     

中国1992-2019年乙型肝炎疫苗免疫及母婴阻断策略的成本效益分析

目的 对我国1992-2019年来实施的乙型肝炎（乙肝）疫苗（HepB）免疫及母婴阻断策略进行卫生经济学评价,为我国乙肝防控策略提供参考。方法 构建决策分析马尔科夫模型,对1992-2019年中国出生的新生儿队列进行分析。模型参数主要来自于文献、年鉴、中国CDC。采用单因素敏感性分析验证模型结果的稳定性。结果 1992-2019年国家共投入直接成本和社会成本分别约374.30亿元和476.10亿元;有效保护了约5 000万人免于成为慢性HBV感染者,减少了1 250万人因HBV感染相关疾病而发生的早死;节约乙肝相关疾病治疗的直接医疗负担和社会医疗负担分别约2.89万亿元和6.92万亿元,实现直接净效益2.85万亿元和社会净效益6.87万亿元。1992-2019年我国实施HepB免疫及母婴阻断策略的直接效益成本比为77.21,社会效益成本比为145.29。结论 1992-2019年我国实施的HepB免疫及母婴阻断策略具有成本-效益收益。     

Downstream health impacts of employment losses during the COVID-19 pandemic

Objectives The Canadian workforce has experienced significant employment losses during the COVID-19 pandemic, in part as a result of non-pharmaceutical interventions to slow COVID-19 transmission. Health consequences are likely to result from these job losses, but without historical precedent for the current economic shutdown they are challenging to plan for. Our study aimed to use population risk models to quantify potential downstream health impacts of the COVID-19 pandemic and inform public health planning to minimize future health burden.MethodsThe impact of COVID-19 job losses on future premature mortality and high-resource health care utilization (HRU) was estimated using an economic model of Canadian COVID-19 lockdowns and validated population risk models. Five-year excess premature mortality and HRU were estimated by age and sex to describe employment-related health consequences of COVID-19 lockdowns in the Canadian population.ResultsWith federal income supplementation like the Canadian Emergency Response Benefit, we estimate that each month of economic lockdown will result in 5.6 new high-resource health care system users (HRUs), and 4.1 excess premature deaths, per 100,000, over the next 5 years. These effects were concentrated in ages 45–64, and among males 18–34. Without income supplementation, the health consequences were approximately twice as great in terms of both HRUs and premature deaths.ConclusionEmployment losses associated with COVID-19 countermeasures may have downstream implications for health. Public health responses should consider financially vulnerable populations at high risk of downstream health outcomes.Supplementary InformationThe online version contains supplementary material available at 10.17269/s41997-021-00588-3.     

Depressive Symptoms Among Older Adults Pre– and Post–COVID-19 Pandemic

ObjectivesIt is a concern that public health measures to prevent older people contracting COVID-19 could lead to a rise in mental health problems such as depression.The aim of this study therefore is to examine trends of depressive symptoms before and during the COVID-19 pandemic in a large cohort of older people.DesignObservational study with 6-year follow-up.Setting & ParticipantsMore than 3000 community-dwelling adults aged ≥60 years participating in The Irish Longitudinal Study on Ageing (TILDA).MethodsMixed effects multilevel models were used to describe trends in depressive symptoms across 3 waves of TILDA: wave 4 (2016), wave 5 (2018), and a final wave conducted July-November 2020. Depressive symptoms were measured using the 8-item Center for Epidemiologic Studies Depression Scale (CES-D), with a score ≥9 indicating clinically significant symptoms.ResultsThe prevalence of clinically significant depressive symptoms at waves 4 and 5 was 7.2% [95% confidence interval (CI) 6.5, 7.9] and 7.2% (95% CI 6.5, 8.0), respectively. This more than doubled to 19.8% (95% CI 18.5, 21.2) during the COVID-19 pandemic. There was no change in CES-D scores between waves 4 and 5 (β = 0.09, 95% CI –0.04, 0.23), but a large increase in symptoms was observed during the pandemic (β = 2.20, 95% CI 2.07, 2.33). Age ≥70 years was independently associated with depressive symptoms (β = 0.45, 95% CI 0.18, 0.72) during the pandemic but not from wave 4 to 5 (β = 0.09, 95% CI –0.18, 0.36). Living with others was associated with a lower burden of symptoms during the pandemic (β = −0.40, 95% CI –0.71, −0.09) but not between waves 4 and 5 (β = −0.40, 95% CI –0.71, −0.09).Conclusions and ImplicationsThis study demonstrates significant increases in the burden of depressive symptoms among older people during the COVID-19 pandemic, particularly those aged ≥70 years and/or living alone. Even a small increase in the incidence of late life depression can have major implications for health care systems and societies in general. Improving access to age-attuned mental health care should therefore be a priority.     

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

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