Global versus focused isolation during the SARS-CoV-2 pandemic-A cost-effectiveness analysis

Shlomai, A.; Leshno, A.; Sklan, E. H.; Leshno, M.

Background: The novel coronavirus (SARS-CoV-2) pandemic is driving many countries to adopt global isolation measures in an attempt to slow-down its spread. These extreme measures are associated with extraordinary economic costs. Objective: To compare the cost-effectiveness of global isolation of the whole population to focused isolation of individuals at high risk of being exposed, augmented by thorough PCR testing. Design: We applied a modified Susceptible, Exposed, Infectious, Removed (SEIR) model to compare two different strategies in controlling the SARS-CoV-2 spread. Data sources and target population: We modeled the dynamics in Israel, a small country with ~ 9 million people. Time horizon: 200 days. Interventions: 1. Global isolation of the whole population (strategy 1) 2. Focused isolation of people at high risk of exposure with extensive PCR testing (strategy 2). Outcome measures: Number of deaths and the cost per one avoided death in strategy 1 vs 2. Results of Base-Case analysis: The number of expected deaths is 389 in strategy 1 versus 432 in strategy 2. The incremental cost-effectiveness ratio (ICER) in case of adhering to global isolation will be $ 102,383,282 to prevent one case of death. Results of sensitivity analysis: The ICER value is between $ 22.5 million to over $280 million per one avoided death. Conclusions: According to our model, global isolation will save ~43 more lives compared to a strategy of focused isolation and extensive screening. This benefit is implicated in tremendous costs that might result in overwhelming economic effects. Limitations: Compartment models do not necessarily fit to countries with heterogeneous populations. In addition, we rely on current published parameters that might not reliably reflect infection dynamics.