Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact firstname.lastname@example.org.
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
47 Pages Posted: 30 Jun 2020More...
Background: Movement restriction policies (MRPs) are effective in preventing/delaying COVID-19 transition 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 so to inform preparation for future waves.
Methods: The SEIR (susceptible, exposed, infectious and recovered) modelling framework was adapted to simulate the health and cost outcomes of initiating MRPs at different times: rapid implementation (23 rd January, the real-world scenario), delayed by one week, delayed by two weeks and delayed by four 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 (DALY), cost and net monetary benefit. Costs were reported in both Chinese currency Renminbi (RMB) and US Dollar value in 2019 (USD).
Findings: The first wave of COVID-19 in China resulted in 55,337 DALYs lost and 382 billion USD losses. 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) per DALY saved, the probability for the rapid implementation to be the optimal strategy was 89%.
Interpretation: Early 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.Funding National Social Science Foundation and Shanghai Municipal Commission of Health and the Family.
Funding Statement: This work is supported by National Social Science Foundation (No. 18BGL235) and Shanghai Municipal Commission of Health and the Family Foundation for Young Talents (2017YQ023).
Declaration of Interests: MP received personal fees from Merck, outside the submitted work. Other than these, the authors declare no competing interests.
Ethics Approval Statement: This study did not access individual patient data. Hence, ethical approval and patient informed consents were not required.
Keywords: COVID-19; Disease Burden; Cost-effectiveness Analysis; Timing; Movement Restriction Policies; DALY
Suggested Citation: Suggested Citation