A new cost-effectiveness study on public health strategies in South Africa

See: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30452-6/fulltext

A new paper has just been out in the Lancet looking at the CE of public health strategies in RSA. The authors use a microsimulation model to estimate the clinical and economic outcomes (over 360 days) for each intervention option, and they do come up with ICERs (!!) per year of life saved.

The interventions are: health-care testing alone, a combination of health-care testing, contact tracing, use of isolation centres, mass symptom screening, and use of quarantine centres. Their results are: a combination of health-care testing, contact tracing, use of isolation centres, mass symptom screening, and use of quarantine centres reduced mortality by 94%, increased health-care costs by 33%, and was cost-effective (ICER $340 per year of life saved).

That’s a really important result, since a national or local lockdown here is not on the table - and what it shows is that a combination of public health interventions could reduce the mortality significantly (in the country obviously)

A few thoughts and Qts:

  • The authors use a health system perspective (from the looks of it) - do you think they could have used a societal perspective, especially as COVID and the public health strategies do trigger different costs in the economy (e.g. even isolating following a positive test will lead to drops of income)?
  • The authors make a lot of assumptions -obviously since this is a modelling exercise- e.g. self-isolation is started from the positive test: in a country like South Africa with loads of high density settlements, multigenerational households, informal sector work and significant rates of poverty – what do you think of those?
  • I wonder whether this is reproducible in other LMICs, and what are the takeaways for other countries in the continent? and also for South Africa moving forward (they did instate a lockdown really early on in the pandemic).

All in all, a really interesting paper. I love their Table 1 with parameters presented really clearly, plus sensitivity analyses. This can be a bit of a blueprint at least on the writing up, I found it very clear. I am not a modeller - don’t know if anyone has any thoughts about the mechanics and methods? There has only been few CEAs so this is surely a major publication for us all!

Thanks and excited to open the floor with a first post :slight_smile:

Nice one thanks YL!
I am keen on the perspective question…how much of the societal surplus ought commodity manufacturers appropriate given the huge economic/human capital costs? Where does one draw the line? This will be a big question with vaccines…
Need more of this kind of analysis!!
Thanks for posting!