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. 2022 May 12;11(1):90.
doi: 10.1186/s13643-022-01958-9.

Lessons from past pandemics: a systematic review of evidence-based, cost-effective interventions to suppress COVID-19

Carl-Etienne Juneau  1 , Tomas Pueyo  2 , Matt Bell  2 , Genevieve Gee  2 , Pablo Collazzo  3 , Louise Potvin  4
Affiliations

Lessons from past pandemics: a systematic review of evidence-based, cost-effective interventions to suppress COVID-19

Carl-Etienne Juneau et al. Syst Rev. .

Abstract

Background: In an unparalleled global response, during the COVID-19 pandemic, 90 countries asked 3.9 billion people to stay home. Yet other countries avoided lockdowns and focused on other strategies, like contact tracing. How effective and cost-effective are these strategies? We aimed to provide a comprehensive summary of the evidence on past pandemic controls, with a focus on cost-effectiveness.

Methods: Following PRISMA guidelines, MEDLINE (1946 to April week 2, 2020) and EMBASE (1974 to April 17, 2020) were searched using a range of terms related to pandemic control. Articles reporting on the effectiveness or cost-effectiveness of at least one intervention were included.

Results: We found 1653 papers; 62 were included. The effectiveness of hand-washing and face masks was supported by randomized trials. These measures were highly cost-effective. For other interventions, only observational and modelling studies were found. They suggested that (1) the most cost-effective interventions are swift contact tracing and case isolation, surveillance networks, protective equipment for healthcare workers, and early vaccination (when available); (2) home quarantines and stockpiling antivirals are less cost-effective; (3) social distancing measures like workplace and school closures are effective but costly, making them the least cost-effective options; (4) combinations are more cost-effective than single interventions; and (5) interventions are more cost-effective when adopted early. For 2009 H1N1 influenza, contact tracing was estimated to be 4363 times more cost-effective than school closure ($2260 vs. $9,860,000 per death prevented).

Conclusions and contributions: For COVID-19, a cautious interpretation suggests that (1) workplace and school closures are effective but costly, especially when adopted late, and (2) scaling up as early as possible a combination of interventions that includes hand-washing, face masks, ample protective equipment for healthcare workers, and swift contact tracing and case isolation is likely to be the most cost-effective strategy.

Keywords: COVID-19; Cost-effectiveness; Epidemic interventions; Non-pharmaceutical interventions; Outbreak control; Pandemic control.

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Conflict of interest statement

TP, MB, PC, and LP declare that they have no competing interests. GG holds a contractual position with the Millar Group (a provider of personal protective equipment) and executive roles at Panacea Health Solutions and Angular Momentum (providers of diabetes and corporate wellness programmes). CEJ has contractual agreements with the Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l'Ile-de-Montreal (CIUSSS) and is founder of Dr. Muscle and the COVID-19 Science Updates (https://covid1.substack.com/).

Figures

Fig. 1
Fig. 1
Cost-effectiveness of interventions in COVID-19, by stage
See this image and copyright information in PMC

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