Cost-Effectiveness of the COVID-19 Test, Trace and Isolate Program in Colombia

Abstract

Background: The WHO recommends use of masks and social distancing to reduce transmission and death from COVID-19. Governments worldwide also rely on test-trace-isolate (TTI) programs for additional risk mitigation. This study aims to estimate the cost-effectiveness of implementing a national TTI strategy to reduce the number of severe and fatal cases of COVID-19 in Colombia. Methods: We developed a simulation model of COVID-19 infection combined with a Susceptible-Infected-Recovered structure. We estimated the incremental cost-effectiveness of a comprehensive TTI strategy compared to no intervention over a one-year horizon, from both a health system and a societal perspective. Hospitalization and mortality rates were retrieved from Colombian surveillance data. We included program costs of TTI intervention, health services utilization, PCR diagnosis test, productivity lost, and government social program costs. We used the number of deaths and quality-adjusted life years (QALYs) as health outcomes. Sensitivity analyses were performed. Findings: Compared with no intervention, the TTI strategy reduced COVID-19 mortality by 67%. In addition, the program saved an average of $1,045 and $850 per case in the social and health system perspective, respectively. These savings are equivalent to almost four to ten times the annual Colombia per capita healthcare spending.Interpretation: The TTI strategy in Colombia is a highly cost-effective public health intervention to reduce the burden of COVID-19. TTI is dependent on its capacity to identify and give early medical and social assistance to new cases. Our findings exemplify the success of using comprehensive strategies integrating telemedicine and predictive analysis to improve prevention programs.Funding Information: This study was supported by the Colombian Ministry of Health through award number PUJ-04519-20 received by E.P. AVO and SDS declined to receive any funding support for this study.Declaration of Interests: Three of the authors (JFN, MRB, and FR) are direct employees of the funding institution (Colombian Ministry of Health). The other authors do not present any conflict of interest.Ethics Approval Statement: This study was approved by the Institutional Review Board of the Johns Hopkins Bloomberg School of Public Health and deemed not human subjects research (IRB number: 14144).