COVID-19 Health Economics: Looking Back and Scoping the Future

Abstract

As of March 2022, nearly 6 million people have died of COVID-19 globally.1WHO coronavirus (COVID-19) dashboard. World Health Organization.https://covid19.who.intDate accessed: April 3, 2022Google Scholar The COVID-19 pandemic has already gone through several distinct stages during the first 2 years, with noticeable health and health economics impact at each stage. The initial emergency stage resulted in lockdowns that incurred enormous societal costs, concerning gross domestic product reductions as well as (mental) health damages. Diagnostic tests were implemented on a never-before-seen scale in many healthcare systems, without health economics justification,2Stevenson M. Metry A. Messenger M. Modelling of hypothetical SARS-CoV-2 point-of-care tests on admission to hospital from A&E: rapid cost-effectiveness analysis.Health Technol Assess. 2021; 25: 1-68Crossref Scopus (4) Google Scholar,3Stevenson M. Metry A. Messenger M. Modelling of hypothetical SARS-CoV-2 point of care tests for routine testing in residential care homes: rapid cost-effectiveness analysis.Health Technol Assess. 2021; 25: 1-74Crossref Scopus (6) Google Scholar as exemplified in a systematic review in this themed section.4Elvidge J. Summerfield A. Nicholls D. Dawoud D. Diagnostics and treatments of COVID-19: a living systematic review of economic.Value Health. 2022; 25: 773-784Abstract Full Text Full Text PDF Scopus (2) Google Scholar In the second stage, vaccines were introduced in Western countries without the general health economic considerations that generally apply in evaluations of country-specific national immunization technological advisory groups.5Joint Committee on Vaccination and Immunisation. UK Gov.https://www.gov.uk/government/groups/joint-committee-on-vaccination-and-immunisationDate accessed: April 3, 2022Google Scholar In the third stage, health economic considerations on emerging treatments remain scarce, as we previously addressed in a previous Value in Health–themed section on COVID-19.6Chhatwal J. Postma M.J. Health economics of interventions to tackle the coronavirus 2019 pandemic.Value Health. 2021; 24: 605-606Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar The recent Omicron variant—potentially associated with less severe disease—resulted in a different phase in the pandemic, with emergency actions being replaced by considerate actions inclusive of health economic considerations. This themed section aims to look back on the abovementioned issues from a health economics point of view and identify emerging topics in COVID-19 health economics. The initial response to the pandemic was based on nonpharmaceutical interventions, including closing schools, working from home, restricting large gatherings, and closing of restaurants, bars, sports facilities, and businesses. Because of the urgency of the situation, immediate actions were taken without thoroughly evaluating the effectiveness, harms, costs, and benefits upfront of such interventions. Three articles in this themed section tried to estimate these impacts retrospectively. The article by Sun et al7Sun J. Zheng Y. Liang W. et al.Quantifying the effect of public activity intervention policies on COVID-19 pandemic containment using epidemiological data from 145 countries.Value Health. 2022; 25: 699-708Abstract Full Text Full Text PDF Scopus (1) Google Scholar analyzed the data from 145 countries in the Oxford COVID-19 government response tracker, identifying that the effectiveness of interventions was higher in the early stages of outbreaks than in later stages. Closing of schools, workplaces, and public events showed the highest effectiveness, whereas closing public transport and controlling international travel were effective but to a lesser extent. The study by van Baal et al8Wouterse B. Ram F. van Baal P. Quality-adjusted life-years lost due to COVID-19 mortality: methods and application for The Netherlands.Value Health. 2022; 25: 731-735Abstract Full Text Full Text PDF Scopus (1) Google Scholar estimated COVID-19 mortality and loss in quality-adjusted life-years despite social distancing interventions in 2020. Building on previously described methods9Briggs A.H. Goldstein D.A. Kirwin E. et al.Estimating (quality-adjusted) life-year losses associated with deaths: with application to COVID-19.Health Econ. 2021; 30: 699-707Crossref PubMed Scopus (21) Google Scholar and explicitly taking into account that COVID-19 mortality may concentrate in risk groups of older adults and those with comorbidities, the study estimated that in The Netherlands, excess mortality was 16 308, corresponding to 61 032 quality-adjusted life-years lost in 2020.8Wouterse B. Ram F. van Baal P. Quality-adjusted life-years lost due to COVID-19 mortality: methods and application for The Netherlands.Value Health. 2022; 25: 731-735Abstract Full Text Full Text PDF Scopus (1) Google Scholar Notably, this would translate into increased mortality by greater than 10% when taking the Dutch overall population numbers into account.10Deceased; cause of death, quarter and year of death. StatLine.https://opendata.cbs.nl/statline/#/CBS/nl/dataset/82899NED/tableDate accessed: March 3, 2022Google Scholar The article by Peña-Longobardo et al11Peña-Longobardo L.M. Oliva J. Rodriguez-Sánchez B. The effects of severe acute respiratory syndrome coronavirus 2 on the reported mental health symptoms of nonprofessional carers: an analysis across Europe.Value Health. 2022; 25: 736-743Abstract Full Text Full Text PDF Scopus (1) Google Scholar in this themed section quantified the broad impact of COVID-19 and related interventions on mental health. In particular, informal caregivers of patients with COVID-19 were compared with noncaregivers with regard to scorings on items such as depression, anxiety, and sleep. It was found that informal caregivers in Europe have experienced a more severe effect on mental health than noncaregivers. In the second year of the pandemic, rapidly developed conventional and mRNA vaccines became available. Two articles in this themed section analyzed issues around vaccinations. Vadlamudi et al12Lau O. Vadlamudi V. Immunogenicity and safety of the COVID-19 vaccines compared with control in healthy adults: a qualitative and systematic review.Value Health. 2022; 25: 717-730Abstract Full Text Full Text PDF Scopus (1) Google Scholar analyzed vaccines’ clinical trials for anti–severe acute respiratory syndrome-coronavirus 2 immunoglobulin G antibodies geometric mean titers after 28 days of vaccination. All 16 vaccines identified were considered to report relevant immune responses while maintaining tolerable safety levels concerning reactogenicity. It has become apparent that some safety issues—notably, thrombocytopenia and myocarditis—can only be identified after large-scale use of vaccines, requiring the intensive monitoring that occurs worldwide on COVID-19 vaccines. A specific case study for Spain analyzed the issue of autonomy in vaccine choice (ie, choosing between a heterologous or homologous boosting).13DalRé R. Farré M. Isabe Lucena M. Heterologous COVID-19 vaccination in Spain: a case study of individual autonomy in the real world.Value Health. 2022; 25: 770-772Abstract Full Text Full Text PDF Scopus (2) Google Scholar In particular, the group of essential workers (eg, firefighters, teachers, and police officers) primed with a conventional vaccine could choose to be boosted with the same conventional vaccine or an alternative mRNA vaccine. The article concludes that adequately informed persons can very well weigh their options in choosing vaccines. The finding on the benefits of a certain level of autonomy in vaccine choice can be crucial for designing potential future COVID-19 booster campaigns that achieve maximum coverage. Recently, the first oral antiviral treatment for COVID-19 PF-07321332/ritonavir was approved by the US Food and Drug Administration and the European Medicines Agency. It is now undergoing subsequent health technology assessment in various European Union countries. Off-label, multiple treatments have been used from the beginning of the pandemic. For example, corticosteroids were clinically used, obviously with only scarce evidence. This themed session includes an analysis of its use in patients with nonsevere COVID-19 based on a multicenter network in the Hubei province in China.14Chen Z. Yin X. Tan X. Effectiveness of systemic corticosteroids therapy for nonsevere COVID-19 patients: a multicenter, retrospective, longitudinal cohort study.Value Health. 2022; 25: 709-716Abstract Full Text Full Text PDF Scopus (3) Google Scholar The findings do not support any recommendation for its use in patients with nonsevere COVID-19. Two additional articles estimated the value of remdesivir for COVID-19 treatment and they remain inconclusive.15Rafia R. Martyn-St James M. Harnan S. Metry A. Hamilton J. Wailoo A. A cost-effectiveness analysis of remdesivir for the treatment of hospitalized patients with COVID-19 in England and Wales.Value Health. 2022; 25: 761-769Abstract Full Text Full Text PDF Scopus (2) Google Scholar,16Whittington M. Pearson S. Rind D.M. Campbell J.D. The cost-effectiveness of remdesivir for hospitalized patients with COVID-19.Value Health. 2022; 25: 744-750Abstract Full Text Full Text PDF Scopus (2) Google Scholar Given that the benefits of remdesivir on survival are highly uncertain, cost-effectiveness broadly ranges from potentially highly cost-effective to excessively not cost-effective, fully depending on the unknown survival benefits.17Chhatwal J, Basu A. Cost-effectiveness of remdesivir for COVID-19 treatment: what are we missing? Value Health. 2022;25(5):697-698. https://doi.org/10.1016/j.jval.2022.02.002.Google Scholar The final article in this themed section retrospectively analyzes the healthcare resource use of patients with COVID-19 based on a geographically diverse all-payer hospital administrative database in the United States.18Moon R.C. Brown H. Rosenthal N. Healthcare resource utilization of patients with COVID-19 visiting US hospitals.Value Health. 2022; 25: 751-760Abstract Full Text Full Text PDF Scopus (2) Google Scholar High levels of healthcare resource use and in-hospital mortality were found and that 1 in 3 inpatients required posthospital care services. With the COVID-19 pandemic potentially—and hopefully—entering a new phase defined by an endemic-like situation, the role of health economics in decision making is likely going to increase. Specific analyses on resource utilization by patients with COVID-19, such as the abovementioned featured in this themed section, will support the evaluation of the cost-effectiveness of COVID-19 interventions. In summary, this COVID-19 themed section highlights several important topics, including the effect of COVID-19 on mental health, autonomous choices in vaccine boosting to optimize coverage, the cost-effectiveness of different vaccination and treatment strategies, and clinical utilities of dynamic testing approaches. Future studies could evaluate the cost-effectiveness of frequency and type of COVID-19 boosters and the value of COVID-19 testing and treatment in different settings as COVID-19 transitions from a pandemic to an endemic phase. Author Contributions: Concept and design: Postma, Chhatwal Acquisition of data: Postma, Chhatwal Analysis and interpretation of data: Postma, Chhatwal Drafting of the manuscript: Postma, Chhatwal Critical revision of the paper for important intellectual content: Postma, Chhatwal Supervision: Postma, Chhatwal Conflict of Interest Disclosures: Dr Postma reported receiving a grant from Janssen Pharmaceuticals on COVID-19 modeling; reported receiving honoraria from Janssen Pharmaceuticals; and reported serving as a member of the UK Joint Committee Vaccination and Immunization. Dr Chhatwal reported being a partner with Value Analytics Labs, a healthcare consulting company; and reported receiving personal fees from Novo Nordisk and Flatiron outside the submitted work. Drs Postma and Chhatwal are editors for Value in Health and had no role in the peer-review process of this article. Funding/Support: This work was supported by a National Science Foundation award 2035361. Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The Effects of Severe Acute Respiratory Syndrome Coronavirus 2 on the Reported Mental Health Symptoms of Nonprofessional Carers: An Analysis Across EuropeValue in HealthVol. 25Issue 5PreviewThis study tries to analyze how the crisis generated by severe acute respiratory syndrome coronavirus 2 has affected the reported mental health symptoms of informal caregivers in different European countries. Full-Text PDF Effectiveness of Systemic Corticosteroids Therapy for Nonsevere Patients With COVID-19: A Multicenter, Retrospective, Longitudinal Cohort StudyValue in HealthVol. 25Issue 5PreviewCorticosteroids were clinically used in the treatment of nonsevere patients with COVID-19, but the efficacy of such treatment lacked sufficient clinical evidence, and the impact of dose had never been studied. This study aimed to evaluate the effect of systemic corticosteroid use (SCU) in nonsevere patients with COVID-19. Full-Text PDF Quantifying the Effect of Public Activity Intervention Policies on COVID-19 Pandemic Containment Using Epidemiologic Data From 145 CountriesValue in HealthVol. 25Issue 5PreviewMost countries have adopted public activity intervention policies to control the coronavirus disease 2019 (COVID-19) pandemic. Nevertheless, empirical evidence of the effectiveness of different interventions on the containment of the epidemic was inconsistent. Full-Text PDF Immunogenicity and Safety of the COVID-19 Vaccines Compared With Control in Healthy Adults: A Qualitative and Systematic ReviewValue in HealthVol. 25Issue 5PreviewEmergence of severe acute respiratory syndrome coronavirus 2 infections and the resultant disease, COVID-19 led the world into 238 million cases and 4.8 million deaths over the first 22 months of the pandemic. While numerous vaccines have been developed to combat this pandemic, limited literature is available regarding the comparison of these vaccines. This study aims to systematically review and evaluate the immunogenicity and safety of COVID-19 vaccines compared with control arms in the healthy adult population. Full-Text PDF Heterologous COVID-19 Vaccination in Spain: A Case Study of Individual Autonomy in the Real WorldValue in HealthVol. 25Issue 5PreviewIn Spain, 1.5 million essential < 60-year-old workers were vaccinated with a first AstraZeneca vaccine dose. After assessing the cases of thrombosis with thrombocytopenia associated to this vaccine, the European Medicines Agency (EMA) supported the administration of 2 doses of the AstraZeneca vaccine with no age restrictions. Nevertheless, Spain decided not to administer the second dose of this vaccine to < 60-year-olds. The government sponsored a clinical trial (CombiVacS) to assess the immunogenicity response to a Pfizer/BioNTech vaccine dose in adults primed with the AstraZeneca vaccine. Full-Text PDF The Cost-Effectiveness of Remdesivir for Hospitalized Patients With COVID-19Value in HealthVol. 25Issue 5PreviewThis study aimed to estimate the cost-effectiveness of remdesivir, the first novel therapeutic to receive Emergency Use Authorization for the treatment of hospitalized patients with COVID-19, and identify key drivers of value to guide future pricing and reimbursement efforts. Full-Text PDF Diagnostics and Treatments of COVID-19: A Living Systematic Review of Economic EvaluationsValue in HealthVol. 25Issue 5PreviewAs healthcare systems continue to respond to the COVID-19 pandemic, cost-effectiveness evidence will be needed to identify which tests and treatments for COVID-19 offer value for money. We sought to review economic evaluations of diagnostic tests and treatments for COVID-19, critically appraising the methodological approaches used and reporting cost-effectiveness estimates, using a “living” systematic review approach. Full-Text PDF Open AccessA Cost-Effectiveness Analysis of Remdesivir for the Treatment of Hospitalized Patients With COVID-19 in England and WalesValue in HealthVol. 25Issue 5PreviewCOVID-19 is associated with significant morbidity and mortality. This study aims to synthesize evidence to assess the cost-effectiveness of remdesivir (RDV) for the treatment of hospitalized patients with COVID-19 in England and Wales. Full-Text PDF Cost-Effectiveness of Remdesivir for COVID-19 Treatment: What Are We Missing?Value in HealthVol. 25Issue 5PreviewSince the beginning of the COVID-19 pandemic, at least 5.6 million people have died of COVID-19 globally as of January 2022.1 In the early stages of the pandemic, nonpharmaceutical interventions (eg, closure of business, social distancing) were the primary mode of controlling the spread of the novel coronavirus, severe acute respiratory syndrome coronavirus 2, thereby reducing COVID-19–associated hospitalizations and deaths. One study estimated the total cost of the COVID-19 pandemic in the United States to be at least $16 trillion. Full-Text PDF Healthcare Resource Utilization of Patients With COVID-19 Visiting US HospitalsValue in HealthVol. 25Issue 5PreviewSevere cases of COVID-19 have overwhelmed hospital systems across the nation. This study aimed to describe the healthcare resource utilization of patients with COVID-19 from hospital visit to 30 days after discharge for inpatients and hospital-based outpatients in the United States. Full-Text PDF