Open AccessCost-effectiveness and return on investment of protecting health workers in low- and middle-income countries during the COVID-19 pandemic
Author(s) -
Nicholas Risko,
Kalin Werner,
Ogechukwu Agatha Offorjebe,
Andrés I. Vecino-Ortiz,
Lee Wallis,
Junaid Abdul Razzak
Publication year - 2020
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0240503
Subject(s) - personal protective equipment , investment (military) , activity based costing , return on investment , pandemic , environmental health , health care , scale (ratio) , medicine , business , covid-19 , economic growth , economics , geography , disease , pathology , politics , political science , infectious disease (medical specialty) , law , cartography , marketing , production (economics) , macroeconomics
Background In this paper, we predict the health and economic consequences of immediate investment in personal protective equipment (PPE) for health care workers (HCWs) in low- and middle-income countries (LMICs). Methods To account for health consequences, we estimated mortality for HCWs and present a cost-effectiveness and return on investment (ROI) analysis using a decision-analytic model with Bayesian multivariate sensitivity analysis and Monte Carlo simulation. Data sources included inputs from the World Health Organization Essential Supplies Forecasting Tool and the Imperial College of London epidemiologic model. Results An investment of $9.6 billion USD would adequately protect HCWs in all LMICs. This intervention would save 2,299,543 lives across LMICs, costing $59 USD per HCW case averted and $4,309 USD per HCW life saved. The societal ROI would be $755.3 billion USD, the equivalent of a 7,932% return. Regional and national estimates are also presented. Discussion In scenarios where PPE remains scarce, 70–100% of HCWs will get infected, irrespective of nationwide social distancing policies. Maintaining HCW infection rates below 10% and mortality below 1% requires inclusion of a PPE scale-up strategy as part of the pandemic response. In conclusion, wide-scale procurement and distribution of PPE for LMICs is an essential strategy to prevent widespread HCW morbidity and mortality. It is cost-effective and yields a large downstream return on investment.