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

Amir Shlomai; Ari Leshno; Ella H Sklan; Moshe Leshno

In this study, we implemented cost-effectiveness analysis tools of two distinct strategies to slowdown the virus spread in Israel, a small country with a population of 9 million. We show that a complete quarantine of the whole population (strategy 1) will result in a total of ~14,995 infected people and around 389 deaths over a period of 200 days. An alternative strategy of "trace, isolate, test and treat approach" (strategy 2) in which only individuals who are defined as being at highrisk for being exposed are isolated (relaxed isolation) and repeatedly tested will result in a total of 16,658 infected people with 432 deaths. Overall, strategy 1 is expected to save ~43 more lives, but with a cost of $102,383,282 to prevent one case of death, compared to a more focused approach. As usual ICER in cost-effectiveness analyses relates to cost per Quality-adjusted life year (QALY), and in our study the ICER was measured as cost per one avoided death, we suggest an easy transformation from the ICER in this study to the conventional ICER in cost-effectiveness analyses. Assuming that one case of death is equivalent to a loss of 10 QALYs, the ICER would be $102,383,282 divided by 10, resulting in $10.2 million per QALY. This number is extremely higher than the $150,000 per QALY, recommended by Neumann et al. as the threshold of willingness to pay (19) .