Cost-effectiveness of public health strategies for COVID-19 epidemic control in South Africa

Reddy, Krishna P.; Shebl, Fatma M.; Foote, Julia H. A.; Harling, Guy; Scott, Justine A.; Panella, Christopher; Flanagan, Clare; Hyle, Emily P.; Neilan, Anne M.; Mohareb, Amir M.; Bekker, Linda-Gail; Lessells, Richard J.; Ciaranello, Andrea L.; Wood, Robin; Losina, Elena; Freedberg, Kenneth A.; Kazemian, Pooyan; Siedner, Mark J.

BACKGROUND: Healthcare resource constraints in low and middle-income countries necessitate selection of cost-effective public health interventions to address COVID-19. METHODS: We developed a dynamic COVID-19 microsimulation model to evaluate clinical and economic outcomes and cost-effectiveness of epidemic control strategies in KwaZulu-Natal, South Africa. Interventions assessed were Healthcare Testing (HT), where diagnostic testing is performed only for those presenting to healthcare centres; Contact Tracing (CT) in households of cases; Isolation Centres (IC), for cases not requiring hospitalisation; community health worker-led Mass Symptom Screening and diagnostic testing for symptomatic individuals (MS); and Quarantine Centres (QC), for contacts who test negative. Given uncertainties about epidemic dynamics in South Africa, we evaluated two main epidemic scenarios over 360 days, with effective reproduction numbers (R(e)) of 1·5 and 1·2. We compared HT, HT+CT, HT+CT+IC, HT+CT+IC+MS, HT+CT+IC+QC, and HT+CT+IC+MS+QC, considering strategies with incremental cost-effectiveness ratio (ICER)