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Background The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was first reported in China, which caused a respiratory disease known as Coronavirus Disease 2019 (COVID-19). Since its discovery, the virus has spread to over 160 countries and claimed more than 9800 deaths. This study aimed to assess the effectiveness and cost-effectiveness of various response public health measures.
Methods The stochastic agent-based model was used to simulate the process of COVID-19 outbreak in scenario I (imported one case) and II (imported four cases) with a series of public health measures, involving the personal protection, isolation-and-quarantine, gathering restriction, and community containment. The virtual community was constructed following the susceptible-latent-infectious-recovered framework. The epidemiological and economic parameters derived from the previous literature and field investigation. The main outcomes included avoided infectors, cost-effectiveness ratios (CERs), and incremental cost-effectiveness ratios (ICERs). The sensitivity analyses were undertaken to assess uncertainty.
Results In scenario I and II, the isolation-and-quarantine averted 1696 and 1990 humans infected respectively at the cost of US$12 428 and US$58 555, both with negative value of ICERs. The joint strategy of personal protection and isolation-and-quarantine could avert one more case than single isolation-and-quarantine with additional cost of US$166 871 and US$180 140 respectively. The effectiveness of isolation-and-quarantine decreased as lowering quarantine probability and increasing delay-time. Especially in scenario II, when the quarantine probability was less than 25%, the number of infections raised sharply; when the quarantine delay-time reached six days, more than a quarter of individuals would be infected in the community. The strategy including community containment could protect more lives and was cost-effective, when the number of imported cases was no less than 65, or the delay-time of quarantine was more than five days, or the quarantine probability was below 25%, based on current assumptions.
Conclusions The isolation-and-quarantine was the most cost-effective intervention. However, personal protection and isolation-and-quarantine was the optimal strategy averting more infectors than single isolation-and-quarantine. Certain restrictions should be considered, such as more initial imported cases, longer quarantine delay-time and lower quarantine probability.
### Competing Interest Statement
The authors have declared no competing interest.
### Funding Statement
This work was supported by the Chinese National Natural Fund (81573258); Jiangsu Provincial Major Science & Technology Demonstration Project (BE2015714, BE2017749); Jiangsu Provincial Six Talent Peak (WSN-002); and Jiangsu Provincial Key Medical Discipline (ZDXKA2016008).The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.
### Author Declarations
All relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript.
Yes
All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.
Yes
I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
Yes
I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.
Yes
The data derived from previous study and they were available.
* COVID-19
: coronavirus disease 2019
SARS
: Severe Acute Respiratory Syndrome
MERS
: Middle East Respiratory Syndrome
NPIs
: nonpharmaceutical interventions
ABM
: agent-based model
SLIR
: susceptible-latent-infectious-recovered
OR
: odds ratio
RR
: relative risk
CDC
: Center for Disease Control and Prevention
GDP
: Gross Domestic Product
PCDI
: per capita disposable income
CERs
: cost-effectiveness ratios
ICERs
: Incremental cost-effectiveness ratios
SD
: standard deviation
Effectiveness and cost-effectiveness of public health measures to control COVID-19: a modelling study
Qiang Wang, Naiyang Shi, Jinxin Huang, Tingting Cui, Liuqing Yang, Jing Ai, Hong Ji, Ke Xu, Tauseef Ahmad, Changjun Bao, Hui Jin
doi: https://doi.org/10.1101/2020.03.20.20039644
Qiang Wang, Naiyang Shi, Jinxin Huang, Tingting Cui, Liuqing Yang, Jing Ai, Hong Ji, Ke Xu, Tauseef Ahmad, Changjun Bao, Hui Jin
doi: https://doi.org/10.1101/2020.03.20.20039644