Cost of the COVID-19 pandemic versus the cost-effectiveness of mitigation strategies in EU/UK/OECD: a systematic review

Abstract

Objectives: The economic burden of COVID-19 pandemic is substantial, with both direct and indirect costs playing a significant role.

Design: A systematic literature review was conducted to estimate the cost of the COVID-19 pandemic and the cost-effectiveness of pharmaceutical or non-pharmaceutical interventions. All cost data were adjusted to the 2021 Euro, and interventions compared with null.

Data sources: Ovid MEDLINE and EMBASE were searched from January 2020 through 22 April 2021.

Eligibility criteria: Studies regarding COVID-19 outbreak or public health preparedness measures or interventions with outcome measures related to the direct and indirect costs for disease and preparedness and/or response in countries of the European Union (EU), the European Economic Area (EEA), the UK and the Organisation for Economic Co-operation and Development (OECD) of all relevant epidemiological designs which estimate cost within the selected time frame were considered eligible.

Data extraction and synthesis: Studies were searched, screened and coded independently by two reviewers with high measure of inter-rater agreement. Data were extracted to a predefined data extraction sheet. The risk of bias was assessed using the Consensus on Health Economic Criteria checklist.

Results: We included data from 41 economic studies. Ten studies evaluated the cost of the COVID-19 pandemic, while 31 assessed the cost-benefit of public health surveillance, preparedness and response measures. Overall, the economic burden of the COVID-19 pandemic was found to be substantial. Community screening, bed provision policies, investing in personal-protective-equipment and vaccination strategies were cost-effective. Physical distancing measures were associated with health benefits; however, their cost-effectiveness was dependent on the duration, compliance and the phase of the epidemic in which it was implemented.

Conclusions: COVID-19 pandemic is associated with substantial short-term and long-term economic costs to healthcare systems, payers and societies, while interventions including testing and screening policies, vaccination and physical distancing policies were identified as those presenting cost-effective options to deal with the pandemic, dependent on population vaccination and the R_e at the stage of the pandemic.

Keywords: COVID-19; SARS-CoV-2 infection; health economics.

Figure 1

PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis) flow chart of the search strategy.

Figure 2

ICER results for testing and screening strategies. ACS, alternative care site; ICER, incremental cost-effectiveness ratio; QALY, Quality-Adjusted Life Years.

Figure 3

ICER results for vaccination and treatment strategies. FFS, fee for service payment; ICER, incremental cost-effectiveness ratio; QALY, Quality-Adjusted Life Years.