Model-based evaluation of the COVID-19 epidemiological impact on international visitors during Expo 2020.

The impact of the COVID-19 pandemic on large events has been substantial. In this work, an evaluation of the potential impact of international arrivals due to Expo 2020 in terms of potential COVID-19 infections from October 1st, 2021, until the end of April 2022 in the United Arab Emirates is presented. Our simulation results indicate that: (i) the vaccination status of the visitors appears to have a small impact on cases, this is expected as the small numbers of temporary visitors with respect to the total population contribute little to the herd immunity status; and (ii) the number of infected arrivals is the major factor of impact potentially causing a surge in cases countrywide with the subsequent hospitalisations and fatalities. These results indicate that the prevention of infected arrivals should take all precedence priority to mitigate the impact of international visitors with their vaccination status being of less relevance.

Modelling the effect of non-pharmaceutical interventions on COVID-19 transmission from mobility maps.

The world has faced the COVID-19 pandemic for over two years now, and it is time to revisit the lessons learned from lockdown measures for theoretical and practical epidemiological improvements. The interlink between these measures and the resulting change in mobility (a predictor of the disease transmission contact rate) is uncertain. We thus propose a new method for assessing the efficacy of various non-pharmaceutical interventions (NPI) and examine the aptness of incorporating mobility data for epidemiological modelling. Facebook mobility maps for the United Arab Emirates are used as input datasets from the first infection in the country to mid-Oct 2020. Dataset was limited to the pre-vaccination period as this paper focuses on assessing the different NPIs at an early epidemic stage when no vaccines are available and NPIs are the only way to reduce the reproduction number ( R 0 ). We developed a travel network density parameter ß t to provide an estimate of NPI impact on mobility patterns. Given the infection-fatality ratio and time lag (onset-to-death), a Bayesian probabilistic model is adapted to calculate the change in epidemic development with ß t . Results showed that the change in ß t clearly impacted R 0 . The three lockdowns strongly affected the growth of transmission rate and collectively reduced R 0 by 78% before the restrictions were eased. The model forecasted daily infections and deaths by 2% and 3% fractional errors. It also projected what-if scenarios for different implementation protocols of each NPI. The developed model can be applied to identify the most efficient NPIs for confronting new COVID-19 waves and the spread of variants, as well as for future pandemics.

Impact of the Sinopharm's BBIBP-CorV vaccine in preventing hospital admissions and death in infected vaccinees: Results from a retrospective study in the emirate of Abu Dhabi, United Arab Emirates (UAE).

BACKGROUND: This is a community-based, retrospective, observational study conducted to determine effectiveness of the BBIBP-CorV inactivated vaccine in the real-world setting against hospital admissions and death. STUDY DESIGN: Study participants were selected from 214,940 PCR-positive cases of COVID-19 reported to the Department of Health, Abu Dhabi Emirate, United Arab Emirates (UAE) between September 01, 2020 and May 1, 2021. Of these, 176,640 individuals were included in the study who were aged ≥ 15 years with confirmed COVID-19 positive status who had records linked to their vaccination status. Those with incomplete or missing records were excluded (n = 38,300). Study participants were divided into three groups depending upon their vaccination status: fully vaccinated (two doses), partially vaccinated (single dose), and non-vaccinated. Study outcomes included COVID-19-related admissions to hospital general and critical care wards and death. Vaccine effectiveness for each outcome was based on the incidence density per 1000 person-years. RESULTS: The fully-, partially- and non-vaccinated groups included 62,931, 21,768 and 91,941 individuals, respectively. Based on the incidence rate ratios, the vaccine effectiveness in fully vaccinated individuals was 80%, 92%, and 97% in preventing COVID-19-related hospital admissions, critical care admissions, and death, respectively, when compared to the non-vaccinated group. No protection was observed for critical and non-critical care hospital admissions for the partially vaccinated group, while some protection against death was apparent, although statistically insignificant. CONCLUSIONS: In a COVID-19 pandemic, use of the Sinopharm BBIBP-CorV inactivated vaccine is effective in preventing severe disease and death in a two-dose regimen. Lack of protection with the single dose may be explained by insufficient seroconversion and/or neutralizing antibody responses, behavioral factors (i.e., false sense of protection), and/or other biological factors (emergence of variants, possibility of reinfection, duration of vaccine protection, etc.).

Econometric estimation of WHO-CHOICE country-specific costs for inpatient and outpatient health service delivery.

BACKGROUND: Policy makers require information on costs related to inpatient and outpatient health services to inform resource allocation decisions. METHODS: Country data sets were gathered in 2008-2010 through literature reviews, website searches and a public call for cost data. Multivariate regression analysis was used to explore the determinants of variability in unit costs using data from 30 countries. Two models were designed, with the inpatient and outpatient models drawing upon 3407 and 9028 observations respectively. Cost estimates are produced at country and regional level, with 95% confidence intervals. RESULTS: Inpatient costs across 30 countries are significantly associated with the type of hospital, ownership, as well as bed occupancy rate, average length of stay, and total number of inpatient admissions. Changes in outpatient costs are significantly associated with location, facility ownership and the level of care, as well as to the number of outpatient visits and visits per provider per day. CONCLUSIONS: These updated WHO-CHOICE service delivery unit costs are statistically robust and may be used by analysts as inputs for economic analysis. The models can predict country-specific unit costs at different capacity levels and in different settings.

Bargaining and the provision of health services.

We model and compare the bargaining process between a purchaser of health services, such as a health authority, and a provider (the hospital) in three plausible scenarios: (a) activity bargaining: the purchaser sets the price and activity (number of patients treated) is bargained between the purchaser and the provider; (b) price bargaining: the price is bargained between the purchaser and the provider, but activity is chosen unilaterally by the provider; (c) efficient bargaining: price and activity are simultaneously bargained between the purchaser and the provider. We show that: (1) if the bargaining power of the purchaser is high (low), efficient bargaining leads to higher (lower) activity and purchaser's utility, and lower (higher) prices and provider's utility compared to price bargaining. (2) In activity bargaining, prices are lowest, the purchaser's utility is highest and the provider's utility is lowest; activity is generally lowest, but higher than in price bargaining for high bargaining power of the purchaser. (3) If the purchaser has higher bargaining power, this reduces prices and activity in price bargaining, it reduces prices but increases activity in activity bargaining, and it reduces prices but has no effect on activity in efficient bargaining.

Cost effectiveness of strategies to combat chronic obstructive pulmonary disease and asthma in sub-Saharan Africa and South East Asia: mathematical modelling study.

OBJECTIVES: To determine the population level costs, effects, and cost effectiveness of selected, individual based interventions to combat chronic obstructive pulmonary disease (COPD) and asthma in the context of low and middle income countries. DESIGN: Sectoral cost effectiveness analysis using a lifetime population model. SETTING: Two World Health Organization sub-regions of the world: countries in sub-Saharan Africa with very high adult and high child mortality (AfrE); and countries in South East Asia with high adult and high child mortality (SearD). DATA SOURCES: Disease rates and profiles were taken from the WHO Global Burden of Disease study; estimates of intervention effects and resource needs were drawn from clinical trials, observational studies, and treatment guidelines. Unit costs were taken from a WHO price database. MAIN OUTCOME MEASURES: Cost per disability adjusted life year (DALY) averted, expressed in international dollars ($Int) for the year 2005. RESULTS: In both regions low dose inhaled corticosteroids for mild persistent asthma was considered the most cost effective intervention, with average cost per DALY averted about $Int2500. The next best value strategies were influenza vaccine for COPD in Sear-D (incremental cost $Int4950 per DALY averted) and low dose inhaled corticosteroids plus long acting ß agonists for moderate persistent asthma in Afr-E (incremental cost $Int9112 per DALY averted). CONCLUSIONS: COPD is irreversible and progressive, and current treatment options produce relatively little gains relative to the cost. The treatment options available for asthma, however, generally decrease chronic respiratory disease burden at a relatively low cost.

Towards an improved investment approach for an effective response to HIV/AIDS.

Substantial changes are needed to achieve a more targeted and strategic approach to investment in the response to the HIV/AIDS epidemic that will yield long-term dividends. Until now, advocacy for resources has been done on the basis of a commodity approach that encouraged scaling up of numerous strategies in parallel, irrespective of their relative effects. We propose a strategic investment framework that is intended to support better management of national and international HIV/AIDS responses than exists with the present system. Our framework incorporates major efficiency gains through community mobilisation, synergies between programme elements, and benefits of the extension of antiretroviral therapy for prevention of HIV transmission. It proposes three categories of investment, consisting of six basic programmatic activities, interventions that create an enabling environment to achieve maximum effectiveness, and programmatic efforts in other health and development sectors related to HIV/AIDS. The yearly cost of achievement of universal access to HIV prevention, treatment, care, and support by 2015 is estimated at no less than US$22 billion. Implementation of the new investment framework would avert 12·2 million new HIV infections and 7·4 million deaths from AIDS between 2011 and 2020 compared with continuation of present approaches, and result in 29·4 million life-years gained. The framework is cost effective at $1060 per life-year gained, and the additional investment proposed would be largely offset from savings in treatment costs alone.

Do waiting times reduce hospital costs?

Using a sample of 137 hospitals over the period 1998-2002 in the English National Health Service, we estimate the elasticity of hospital costs with respect to waiting times. Our cross-sectional and panel-data results suggest that at the sample mean (103 days), waiting times have no significant effect on hospitals' costs or, at most, a positive one. If significant, the elasticity of cost with respect to waiting time from our cross-sectional estimates is in the range 0.4-1. The elasticity is still positive but lower in our fixed-effects specifications (0.2-0.4). In all specifications, the effect of waiting time on cost is non-linear, suggesting a U-shaped relationship between hospital costs and waiting times. However, the level of waiting time which minimises total costs is always below ten days.

The economic impact of chronic diseases: how do households respond to shocks? Evidence from Russia.

The epidemiological burden of chronic diseases is increasing worldwide and there is very little empirical evidence regarding the economic impact of chronic diseases on individuals and households. The primary objective of this paper is to explore the evidence on how chronic diseases affect household healthcare expenditure, non-health consumption, labour (earned) income, and to demonstrate how transfers may provide some insurance against shocks from chronic diseases. We have explicated a two-part Heckit model on household level data obtained from the Living Standard Measurement Surveys (LSMS) from Russia to control for nontrivial proportion of zeros in the dependent variables, skewed distribution of expenditure data and endogeneity. The results indicate that chronic diseases are significantly associated with higher levels of household healthcare expenditure in Russia and productivity losses reflected by reduced labour supply and reduced household labour income. Non-healthcare expenditure also increased. Results suggest that households are able to insure non-health consumption against chronic diseases, possibly from transfers, which also increased. In addition, socioeconomic status indicators significantly explained the impact of chronic diseases on households. Insurance and higher average education in households were associated with higher healthcare expenditure. Household transfers were significant in Russia despite an appreciable level of insurance cover. We conclude that households depend on informal coping mechanisms in the face of chronic diseases, irrespective of insurance cover. These results have implications for policies regarding the financing of treatment and control of chronic diseases in the country studied.