Lessons from past pandemics: a systematic review of evidence-based, cost-effective interventions to suppress COVID-19.

Lessons from past pandemics: a systematic review of evidence-based, cost-effective interventions to suppress COVID-19.
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DOI:
10.1186/s13643-022-01958-9
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发表时间:
2022-05-12
期刊:
影响因子:
3.7
通讯作者:
Potvin, Louise
Potvin, Louise
中科院分区:
医学4区
文献类型:
--
作者:
Juneau, Carl-Etienne;Pueyo, Tomas;Bell, Matt;Gee, Genevieve;Collazzo, Pablo;Potvin, Louise

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在新冠肺炎大流行期间,90个国家做出了无与伦比的全球反应,要求39亿人留在家里。然而,其他国家避免了封锁,转而专注于其他策略,比如追踪接触者。这些策略的效果和成本效益如何?我们的目标是全面总结过去大流行控制的证据,重点放在成本效益上。根据PRISMA指南,使用与大流行控制相关的一系列术语搜索MEDLINE(1946年至2020年4月2日)和EMBASE(1974年至2020年4月17日)。报告至少一种干预措施的有效性或成本效益的文章包括在内。我们找到了1653篇论文;其中包括62篇论文。洗手和口罩的有效性得到了随机试验的支持。这些措施具有很高的成本效益。对于其他干预措施,只发现了观察性和模型性研究。他们建议:(1)最具成本效益的干预措施是快速追踪接触者和病例隔离、监测网络、医护人员的防护设备和早期疫苗接种(如果有);(2)家庭隔离和储存抗病毒药物成本较低;(3)工作场所和学校关闭等社会疏远措施有效但成本较高,使其成为成本效益最低的选择;(4)组合干预措施比单一干预措施更具成本效益;以及(5)早期采用的干预措施更具成本效益。对于2009年H1N1流感,接触者追踪的成本效益估计是学校关闭的4363倍(每例预防死亡的费用分别为2260美元和9860,000美元)。对于新冠肺炎来说,谨慎的解读表明,(1)关闭工作场所和学校是有效的,但代价高昂,特别是在较晚采取的情况下,以及(2)尽早扩大干预措施的组合,包括洗手、口罩,为医务人员提供充足的防护装备,以及快速接触者追踪和病例隔离可能是最具成本效益的策略。网上版载有补充材料,可在10.1186/s13643-022-01958-9查阅。
In an unparalleled global response, during the COVID-19 pandemic, 90 countries asked 3.9 billion people to stay home. Yet other countries avoided lockdowns and focused on other strategies, like contact tracing. How effective and cost-effective are these strategies? We aimed to provide a comprehensive summary of the evidence on past pandemic controls, with a focus on cost-effectiveness. Following PRISMA guidelines, MEDLINE (1946 to April week 2, 2020) and EMBASE (1974 to April 17, 2020) were searched using a range of terms related to pandemic control. Articles reporting on the effectiveness or cost-effectiveness of at least one intervention were included. We found 1653 papers; 62 were included. The effectiveness of hand-washing and face masks was supported by randomized trials. These measures were highly cost-effective. For other interventions, only observational and modelling studies were found. They suggested that (1) the most cost-effective interventions are swift contact tracing and case isolation, surveillance networks, protective equipment for healthcare workers, and early vaccination (when available); (2) home quarantines and stockpiling antivirals are less cost-effective; (3) social distancing measures like workplace and school closures are effective but costly, making them the least cost-effective options; (4) combinations are more cost-effective than single interventions; and (5) interventions are more cost-effective when adopted early. For 2009 H1N1 influenza, contact tracing was estimated to be 4363 times more cost-effective than school closure ($2260 vs. $9,860,000 per death prevented). For COVID-19, a cautious interpretation suggests that (1) workplace and school closures are effective but costly, especially when adopted late, and (2) scaling up as early as possible a combination of interventions that includes hand-washing, face masks, ample protective equipment for healthcare workers, and swift contact tracing and case isolation is likely to be the most cost-effective strategy. The online version contains supplementary material available at 10.1186/s13643-022-01958-9.
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