RESUMO
ObjectivesWhile highly effective in preventing SARS-CoV-2 spread, national lockdowns come with an enormous economic price. Few countries have adopted an alternative "testing, tracing, and isolation" approach to selectively isolate people at high exposure risk, thereby minimizing the economic impact. To assist policy makers, we performed a cost-effectiveness analysis of these two strategies. MethodsA modified Susceptible, Exposed, Infectious, Recovered and Deceased (SEIRD) model was employed to assess the situation in Israel, a small country with ~9 million people. The incremental cost-effectiveness ratio (ICER) of these strategies, as well as the expected number of infected individuals and deaths were calculated. ResultsA nationwide lockdown is expected to save on average 274 (median 124, interquartile range (IQR): 71-221) lives compared to the "testing, tracing, and isolation" approach. However, the ICER will be on average $45,104,156 (median $ 49.6 million, IQR: 22.7-220.1) to prevent one case of death. ConclusionsA national lockdown has a moderate advantage in saving lives with tremendous costs and possible overwhelming economic effects. These findings should assist decision-makers dealing with additional waves of this pandemic. HighlightsO_LIDrastic measures of national lockdowns are taken by many countries to slow-down SARS-CoV-2 spread. However, these measures have detrimental economic effects. C_LIO_LIHere we compare two strategies to control the epidemic using a modified SEIRD model: 1. Global national lockdown 2. Focused isolation of people at high exposure risk, following detailed epidemiological investigations. C_LIO_LIWe show that strategy 1 is modestly superior in saving lives compared to strategy 2, but with tremendous costs to prevent one case of death. This might result in overwhelming economic effects that are expected to increase future death toll. C_LI
RESUMO
Colorectal cancer (CRC) is a major health concern. The progression of normal mucosa through adenoma to overt adenocarcinomas span over more than a decade. It provides a window of opportunities for early detection as well as the use of chemopreventive agents such as aspirin. Indeed, CRC can be prevented in up to 80-90% of the cases providing that physicians and patients compliance with current preventive strategies is high. Epidemiological and clinical randomised studies have clearly demonstrated an association between increasing aspirin use and incidence, prevalence and mortality from CRC. Although the evidence supporting the effect of aspirin on colorectal adenomas (CRA) and CRC prevention is consistent, a greater understanding of its mode of action is still needed. Incorporating CRC and CRA benefits into ischemic heart disease (IHD) and Alzheimer disease risk scores would be particularly useful for determining the benefit-to-risk ratio for aspirin use in borderline cases. For instance, patients with a border line annual IHD risk, around 0.7-1.4%, but with a high risk for CRC may still benefit from aspirin usage.
