Disease Burden Attributable to the First Wave of COVID-19 in China and the Effect of Timing on the Cost-Effectiveness of Movement Restriction Policies |
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| Authors: | Jidi Zhao Huajie Jin Xun Li Jianguo Jia Chao Zhang Huijuan Zhao Wuren Ma Zhuozhu Wang Yi He Jimmy Lee Donglan Zhang Bo Yin Weiwei Zheng Haiyin Wang Mark Pennington |
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| Institution: | 1. Department of Public Administration, College of Economics and Management, East China Normal University, Shanghai, China;2. King’s Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience at King’s College London, London, UK;3. Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China;4. Development Institute, Tongji University, Shanghai, China;5. Zhejiang University, Hangzhou, Zhejiang, China;6. Curtin University of Technology, (WA) Australia, Bentley WA, Australia;7. University of California, Los Angeles, Los Angeles, CA, USA;8. Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA;9. Huashan Hospital, Fudan University, Shanghai, China;10. Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China;11. Health Technology Assessment Research Department, Shanghai Health Development Research Centre, Shanghai, China |
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| Abstract: | ObjectivesMovement restriction policies (MRPs) are effective in preventing/delaying COVID-19 transmission but are associated with high societal cost. This study aims to estimate the health burden of the first wave of COVID-19 in China and the cost-effectiveness of early versus late implementation of MRPs to inform preparation for future waves.MethodsThe SEIR (susceptible, exposed, infectious, and recovered) modeling framework was adapted to simulate the health and cost outcomes of initiating MRPs at different times: rapid implementation (January 23, the real-world scenario), delayed by 1 week, delayed by 2 weeks, and delayed by 4 weeks. The end point was set as the day when newly confirmed cases reached zero. Two costing perspectives were adopted: healthcare and societal. Input data were obtained from official statistics and published literature. The primary outcomes were disability-adjusted life-years, cost, and net monetary benefit. Costs were reported in both Chinese renminbi (RMB) and US dollars (USD) at 2019 values.ResultsThe first wave of COVID-19 in China resulted in 38 348 disability adjusted life-years lost (95% CI 19 417-64 130) and 2639 billion RMB losses (95% CI 1347-4688). The rapid implementation strategy dominated all other delayed strategies. This conclusion was robust to all scenarios tested. At a willingness-to-pay threshold of 70 892 RMB (the national annual GDP per capita) per disability-adjusted life-year saved, the probability for the rapid implementation to be the optimal strategy was 96%.ConclusionsEarly implementation of MRPs in response to COVID-19 reduced both the health burden and societal cost and thus should be used for future waves of COVID-19. |
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| Keywords: | COVID-19 cost-effectiveness analysis DALY disease burden movement restriction policies timing |
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