Dynamic zero-COVID strategy in controlling COVID-19 in Shanghai, China: A cost-effectiveness analysis

Abstract

Background: The sustainability and generalizability of China's dynamic zero-COVID strategy on eliminating SARS-CoV-2 transmission has casted doubt globally, mainly because it has exacted high social and economic cost. This study aimed to estimate the disease burden during the first wave of Omicron in China and compared the cost-effectiveness of implementing a Real-world strategy (adjusted dynamic zero-COVID strategy) with two simulated strategies (routine and stricter dynamic zero-COVID strategy) to inform appropriate strategies for COVID-19 pandemic control.

Methods: A dynamic state-transition simulation model was developed to compare the health and cost outcomes between different dynamic zero-COVID strategies. Omicron-related healthcare costs were estimated from the societal perspective. Epidemiological parameter values were derived from data of real-world or generated by model calibration; costs and effectiveness parameter values were informed either by local data or published literature. The primary outcomes were total social cost, disability adjusted life-years (DALYs) and net monetary benefit (NMB). Deterministic sensitivity analyses (DSA) and scenario analyses were performed to assess the model robustness.

Results: The first wave of Omicron in Shanghai resulted in 47,646 DALYs lost and 415 billion RMB losses. At a willingness-to-pay threshold of 173,630 RMB (the GDP per capita of Shanghai in 2021) per DALY saved, the Real-world strategy was considered as the most cost-effective strategy due to its highest NMB (-407 billion). Results from DSA confirmed the robustness of our findings.

Conclusion: Our finding supported the Real-world strategy taken by the Shanghai Municipal Government between March 1 and May 21, 2022 to control the first wave of Omicron outbreak. Moreover, our results indicated that whether the Stricter dynamic zero-COVID strategy is worth implementing at the beginning of the COVID-19 outbreak mainly depended on the infection rate of COVID-19 among primary contacts. Our analysis provides important evidence to inform policy makers to make appropriate decisions regarding COVID-19 pandemic management.

Keywords: China; Cost-effectiveness; Dynamic zero-COVID strategy; Omicron; Shanghai.

Fig. 1

Health states and disease paths of Omicron.

Fig. 2

Deterministic sensitivity analyses results for the Routine strategy compared with the Real-world strategy. Dq, Duration of quarantine; Remployment, employment rate in Shanghai; Sdaily, the daily salary of employees in Shanghai; Remployee leave rate, employee leave rate in Shanghai during the study period; Dcq, duration of centralized quarantine; Qc, centralized quarantine costs per person-day, Fnc, frequency of nucleic acid testing, Dh, duration of hospitalization, TDc, treatment and diagnosis costs per case.

Fig. 3

Deterministic sensitivity analyses results for the Stricter strategy compared with the Real-world strategy. Dq, Duration of quarantine; Remployment, employment rate in Shanghai; Sdaily, the daily salary of employees in Shanghai; Remployee leave rate, employee leave rate in Shanghai during the study period; Dcq, duration of centralized quarantine; Qc, centralized quarantine costs per person-day, Fnc, frequency of nucleic acid testing, Dh, duration of hospitalization, TDc, treatment and diagnosis costs per case.

Fig. 4

Estimated NMBs of the real-world and two simulation strategies under different infection rates of Omicron in the primary contacts. The intersection of the black solid line and the red, green, blue solid lines represents the NMB of each strategy under the real-world infection rate in primary contacts for the Real-world strategy, the Routine strategy and the Stricter strategy, respectively. The intersection of black dotted line and abscissa represents the infection rate in primary contacts that makes the NMBs of the Real-world strategy equal to that of Stricter trategy, respectively. NMB, net monetary benefit.