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

Abstract

Objectives: Movement 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.

Methods: The 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.

Results: The 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%.

Conclusions: 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.

Keywords: COVID-19; DALY; cost-effectiveness analysis; disease burden; movement restriction policies; timing.

Figure 1

The period between the first public release of COVID-19 epidemic data and the implementation of MRPs in different countries. (A) Number of daily new cases of COVID-19 by country. (B) Number of daily new deaths of COVID-19 by country. Day 1 was defined as the first day of public release of COVID-19 epidemic data for each country. The dates of initial movement restrictions and movement restrictions were obtained from government reports and published news and are reported in Appendix 1 in Supplemental Materials found at https://doi.org/10.1016/j.jval.2020.12.009.

Figure 2

Epidemiological model structure. Susceptible = susceptible individuals who have not contracted a COVID-19 infection; Exposed = individuals who have been exposed but are currently asymptomatic, infectious; Infectious = infected individuals who have developed a symptomatic infection, infectious; Hospital = diagnosed infected individuals treated in the hospital; Recovered = infected individuals recovered from COVID-19.

Figure 3

One-way sensitivity analysis results and cost-effectiveness planes. (A) One-way sensitivity analysis results from the healthcare perspective, “One-week delay” versus “No delay”; (B) One-way sensitivity analysis results from the societal perspective, “One-week delay” versus “No delay.” Net monetary benefit = -DALY losses ∗ Chinese GDP – Cost. Each variable tested is reported in the diagram in the following format: Variable name: Base case value [Minimum value – Maximum value].