optimal health and economic impact of non pharmaceutical intervention measures prior CORD-Papers-2022-06-02 (Version 1)

Title: Optimal health and economic impact of non-pharmaceutical intervention measures prior and post vaccination in England: a mathematical modelling study
Abstract: Background Even with good progress on vaccination SARS-CoV-2 infections in the UK may continue to impose a high burden of disease and therefore pose substantial challenges for health policy decision makers. Stringent government-mandated physical distancing measures (lockdown) have been demonstrated to be epidemiologically effective but can have both positive and negative economic consequences. The duration and frequency of any intervention policy could in theory could be optimised to maximise economic benefits while achieving substantial reductions in disease. Methods Here we use a pre-existing SARS-CoV-2 transmission model to assess the health and economic implications of different strengths of control through time in order to identify optimal approaches to non-pharmaceutical intervention stringency in the UK considering the role of vaccination in reducing the need for future physical distancing measures. The model is calibrated to the COVID-19 epidemic in England and we carry out retrospective analysis of the optimal timing of precautionary breaks in 2020 and the optimal relaxation policy from the January 2021 lockdown considering the willingness to pay for health improvement. Results We find that the precise timing and intensity of interventions is highly dependent upon the objective of control. As intervention measures are relaxed we predict a resurgence in cases but the optimal intervention policy can be established dependent upon the willingness to pay (WTP) per QALY loss avoided. Our results show that establishing an optimal level of control can result in a reduction in net monetary loss of billions of pounds dependent upon the precise WTP value. Conclusions It is vital as the UK emerges from lockdown but continues to face an on-going pandemic to accurately establish the overall health and economic costs when making policy decisions. We demonstrate how some of these can be quantified employing mechanistic infectious disease transmission models to establish optimal levels of control for the ongoing COVID-19 pandemic.
Published: 2021-04-25
DOI: 10.1101/2021.04.22.21255949
DOI_URL: http://doi.org/10.1101/2021.04.22.21255949
Author Name: Tildesley M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/tildesley_m
Author Name: Vassall A
Author link: https://covid19-data.nist.gov/pid/rest/local/author/vassall_a
Author Name: Riley S
Author link: https://covid19-data.nist.gov/pid/rest/local/author/riley_s
Author Name: Jit M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/jit_m
Author Name: Sandmann F
Author link: https://covid19-data.nist.gov/pid/rest/local/author/sandmann_f
Author Name: Hill E M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/hill_e_m
Author Name: Thompson R
Author link: https://covid19-data.nist.gov/pid/rest/local/author/thompson_r
Author Name: Atkins B
Author link: https://covid19-data.nist.gov/pid/rest/local/author/atkins_b
Author Name: Edmunds J
Author link: https://covid19-data.nist.gov/pid/rest/local/author/edmunds_j
Author Name: Dyson L M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/dyson_l_m
Author Name: Keeling M J
Author link: https://covid19-data.nist.gov/pid/rest/local/author/keeling_m_j
sha: f91ce3874bb3cf46eeec806effee5b6b580f9454
license: medrxiv
source_x: MedRxiv; WHO
source_x_url: https://www.who.int/
url: https://doi.org/10.1101/2021.04.22.21255949 http://medrxiv.org/cgi/content/short/2021.04.22.21255949v1?rss=1
has_full_text: TRUE
Keywords Extracted from Text Content: lockdown UK SARS-CoV-2 COVID-19 UK SARS-CoV-2 left panel QALYs pubs Fig. 3 SARS-CoV-2 105 COVID φ P B lockdowns =) COVID-19 301 lock-down GDP lockdown NHS [24] . REF https://doi.org Figures S6-S11 long-284 China [1, 2] period(s φ Fig. 4 Hubei province pat-82 terns hos-298 12 WTP children Eng-91 land SARS-CoV-2 85 5th stem £ medRxiv red line left column indi-94 lockdown 158 National Health Service [16 human face 4 Wuhan, 2 NHS blue line dy-240 φ (Fig. 1 φ P B ≥ φ O COVID-19
Extracted Text Content in Record: First 5000 Characters:Even with good progress on vaccination, SARS-CoV-2 infections in the UK may continue to impose a high burden of disease and therefore pose substantial challenges for health policy decision makers. Stringent government-mandated physical distancing measures (lockdown) have been demonstrated to be epidemiologically effective, but can have both positive and negative economic consequences. The duration and frequency of any intervention policy could, in theory, could be optimised to maximise economic benefits while achieving substantial reductions in disease. Here we use a pre-existing SARS-CoV-2 transmission model to assess the health and economic implications of different strengths of control through time in order to identify optimal approaches to non-pharmaceutical intervention stringency in the UK, considering the role of vaccination in reducing the need for future physical distancing measures. The model is calibrated to the COVID-19 epidemic in England and we carry out retrospective analysis of the optimal timing of precautionary breaks in 2020 and the optimal relaxation policy from the January 2021 lockdown, considering the willingness to pay for health improvement. We find that the precise timing and intensity of interventions is highly dependent upon the objective of control. As intervention measures are relaxed, we predict a resurgence in cases, but the optimal intervention policy can be established dependent upon the willingness to pay (WTP) per QALY loss avoided. Our results show that establishing an optimal level of control can result in a reduction in net monetary loss of billions of pounds, dependent upon the precise WTP value. It is vital, as the UK emerges from lockdown, but continues to face an on-going pandemic, to accurately establish the overall health and economic costs when making policy decisions. We demonstrate how some of these can be quantified, employing mechanistic infectious disease transmission models to establish optimal levels of control for the ongoing COVID-19 pandemic. In late 2019, the first cases of an unknown respiratory infection began to emerge in the city of Wuhan, 2 in Hubei province, China [1, 2] . In order to attempt to control the spread of the virus, countries around 3 the world introduced a range of measures, including mandatory physical distancing, wearing of face 4 coverings, restrictions on large gatherings and, in situations where case numbers were increasing in an 5 uncontrolled manner, regional or nationwide policies that have included closure of schools, restrictions 6 on travel and in extreme cases, stay at home orders [3] . 7 In the UK, the first cases of COVID-19 were reported in the city of York on 31st January 2020. Cases 8 began to rise in a concerning manner in March 2020 and on 12th March, the government policy moved 9 from "containment" to "delay", suggesting the imminent introduction of restrictions in order to flatten 10 the peak and avoid the National Health Service (NHS) potentially being overwhelmed in the following 11 weeks. On 20th March, a wave of restrictions were introduced, including the closing of all schools to 12 children other than the vulnerable and those with key worker parents, and the closing of all pubs, 13 restaurants and indoor leisure facilities. Finally, on 23rd March, the UK prime minister announced a 14 national lockdown, in which all individuals had to stay at home and were only allowed out for essential 15 shopping, healthcare, essential work if they could not work from home and one form of exercise per 16 day. 17 As cases continued to decline during April, May and June 2020, mandatory controls were gradually 18 relaxed in order to mitigate further economic harm. in England, schools opened to certain year groups 19 from early June, whilst non-essential shops re-opened on 15th June and pubs and restaurants on 4th 20 July, albeit with physical distancing measures in place in an attempt to control the spread of the virus. 21 As society gradually opened up, cases began to rise again, slowly at first, but increasingly rapidly in 22 September and October. Given the potential for a significant second wave of infection, there was a call 23 from many stakeholders for a short "circuit breaker" lockdown in England, in order to stem the rise 24 in cases and protect the NHS during the winter months. The UK government finally introduced a 4-25 week lockdown on 5th November in England, whilst Scotland, Wales and Northern Ireland introduced 26 similar, short-term mandatory control policies during October and November in an attempt to keep 27 the virus under control. 28 Much of the existing modelling literature on the pandemic has focused explicitly on the impacts of 29 interventions that minimise the direct health impact of the COVID-19 pandemic, such as the number 30 of individuals being admitted to hospital and/or dying from the disease [4] [5] [6] . However, it is important 31 to note that there are non-health benefits and harms that ca
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