Estimating the Costs and Benefits of Supported Quarantine and Isolation in Massachusetts: The Missing Link in Covid-19 Response
Estimating the Costs and Benefits of Supported Quarantine and Isolation in Massachusetts: The Missing Link in Covid-19 Response
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估计马萨诸塞州支持的检疫和隔离的成本和效益：Covid-19 应对中缺失的环节
DOI：
10.2139/ssrn.3790728
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Anne M Hoyt
中科院分区：
文献类型：
--
作者：
M. Bourdeaux;Jessica Kaushal;Linda J. Bilmes;Annmarie Sasdi;Megan Mishra;Anne M Hoyt
导致新冠肺炎疾病的SARS-CoV2疫苗的缓慢推出，以及威胁疫苗效力的病毒变异的出现，表明迫切需要支持非疫苗公共卫生战略，以缓解病毒传播。隔离和隔离是关键的疫情缓解策略，在这些策略中，接触者或感染者分别与其他人保持隔离，直到不再具有传染性。对于SARS-CoV-2，疾控中心建议隔离和隔离期为7-14天。对许多人来说，成功地完成这段分居期可能太难了。挑战可能包括没收工资，放弃购买基本必需品，以及未能履行家庭或社区义务。“支持的”隔离和隔离是指旨在通过提供经济奖励和综合服务来帮助个人克服这些挑战的公共项目，以便他们能够成功地完成隔离期并阻止病毒的传播。本文的目的是评估马萨诸塞州支持的隔离和隔离计划的需求，并描述一个预算模型，以帮助州政府计算在SARS-CoV2疫情期间实施这些计划的成本与不提供这些计划的成本。
为了评估对支持的隔离和隔离计划的需求，我们回顾了有关成功的支持计划的文献，并采访了通过马萨诸塞州接触者追踪计划直接与感染者工作的公共卫生从业者。我们发现隔离和隔离失败的三个主要原因：需要去工作以维持工资，需要购买必需品，以及需要社会服务咨询。我们的模型估计了通过基于家庭和基于设施的计划来应对这些挑战的成本。我们估计，提供这些支持将导致加权平均成本为430美元/人。使用目前对疫情何时消退的预测，以及2020年3月至12月期间平均每天新增病例的数量，我们的模型估计，向感染者及其接触者提供这些服务的费用将在3亿至5.7亿美元之间，这取决于未来211天的感染轨迹和对每个感染者接触者数量的假设。此外，我们还模拟了失败的隔离和隔离的医疗成本，在这些隔离和隔离中，病毒的继续传播不会中断。每个新冠肺炎病例与大约2,500美元/人的医疗费用相关。1该模型估计直接医疗成本对有效生殖数量(RT)或感染者将感染的平均人数的敏感度。一个受支持的减少感染传播的隔离计划可以节省直接的医疗成本。例如，如果一个受支持的隔离计划可以将1.09的平均RT-马萨诸塞州SARS-CoV2疫情到2020年的平均RT-降低到1.06，这种干预可以节省6.1亿美元的医疗成本，超过了该计划在这种发病率和传播水平下的估计成本。虽然估计的节省在高传播水平降低时尤其明显，即使在低传播水平下也是如此，RT的减少与付款人的直接医疗费用降低有关。
The slow rollout of vaccines against SARS-CoV2, the virus that causes Covid-19 disease, and the emergence of viral variants that threaten vaccines’ efficacy demonstrate the urgent need to bolster non-vaccine public health strategies to mitigate viral transmission. Quarantine and isolation are critical epidemic mitigation strategies wherein exposed or infected individuals, respectively, stay apart from others until they are no longer contagious. For SARS-CoV-2, the CDC recommends quarantine and isolation periods ranging from 7-14 days. Successfully completing this period of separation may prove too challenging for many individuals. Challenges may include forfeiting wages, forgoing procurement of basic necessities, and failing to fulfill family or community obligations. “Supported” quarantine and isolation refers to public programs that aim to help individuals overcome these challenges by providing financial incentives and wraparound services so that they can successfully complete separation periods and stop transmission of the virus. The purpose of this paper is to estimate the need for a supported quarantine and isolation program in Massachusetts and to describe a budgeting model to help the state calculate the costs of instituting them, compared to the costs of not providing them, for the duration of the SARS-CoV2 epidemic.
To assess the need for supported quarantine and isolation programs we reviewed the literature on successful support programs and interviewed public health practitioners working directly with infected individuals through the Massachusetts contact tracing program. We found three main drivers of failed quarantine and isolation: the need to go to work to maintain salary, the need to purchase essential necessities, and the need for social services counseling. Our model estimates the costs of addressing these challenges, through both home-based and facility based programs. We assessed that providing these supports would result in a weighted-average cost of $430/person. Using current projections of when the epidemic will resolve and the number of new cases per day averaged over the time period from March-December 2020, our model estimates providing these services to infected individuals and their contacts would be in the range of $300-570 million, depending on the trajectory of infections over the next 211 days and assumptions regarding the number of contacts per infected individual. In addition, we modeled the medical care costs of failed quarantines and isolation, in which onward transmission of the virus is not interrupted. Each Covid-19 case is associated with ~$2,500/person in medical care expenses.1 The model estimates how sensitive direct medical costs are to the Effective Reproduction Number, (Rt), or the average number of people an infected person will in turn infect. A supported quarantine program that reduces infection transmission can offer savings in direct medical costs. For example, if a supported quarantine program could reduce an average Rt of 1.09—the average Rt of the SARS-CoV2 epidemic in Massachusetts through 2020—to 1.06, this intervention could save $610 million in medical costs, exceeding the estimated cost of the program at this level of incidence and transmission. While estimated savings are particularly pronounced when high levels of transmission are brought down, even at low levels of transmission, a reduction in Rt is associated with lower direct medical costs for payors.
影响因子：
9.7
作者：
Bartsch, Sarah M.;Ferguson, Marie C.;Lee, Bruce Y.
通讯作者：
Lee, Bruce Y.