Cost-effectiveness of an online supervised group physical and mental health rehabilitation programme for adults with post-COVID-19 condition after hospitalisation for COVID-19: the REGAIN RCT.

BACKGROUND: Following the COVID-19 pandemic, millions of people continue to experience ongoing physical and mental health sequelae after recovery from acute infection. There is currently no specific treatment for the diverse symptoms associated with post-COVID-19 condition. Physical and mental health rehabilitation may help improve quality of life in such patients. This study reports the cost-effectiveness of a programme of physical and mental health rehabilitation compared to best practice usual care in people with post-COVID-19 condition who were previously hospitalised. METHODS: We conducted an economic evaluation within a randomised controlled trial from the perspective of the UK national health service (NHS) and personnel social services perspective (PSS). Resource used and health-related quality of life were collected using bespoke questionnaire and the EQ-5D-5 L questionnaire at three, six, and 12 months. Incremental costs and quality adjusted life years accrued over the follow-up period were estimated and reported as the incremental cost-effectiveness ratio. Estimate uncertainty was managed by multiple imputation and bootstrapping cost-effectiveness estimates; and displayed graphically on the cost-effectiveness plane. RESULTS: Over a 12-month time horizon, incremental costs and QALYs were £305 (95% CI: -123 to 732) and 0.026 (95% CI: -0.005 to 0.052) respectively. The ICER was £11,941 per QALY indicating cost-effective care. Sensitivity analyses supported the base case findings. The probability of the intervention being cost-effective at a £30,000 per QALY willingness-to-pay threshold was 84%. CONCLUSION: The within-trial economic evaluation suggested that people with post-COVID-19 condition after hospitalisation should be offered a programme of physical and mental health rehabilitation as it likely reflects a cost-effective use of NHS resources. Hospitalisation for COVID-19 has become less commonplace: further evaluation in non-hospitalised patients may be worthwhile. TRIAL REGISTRATION: ISRCTN registry ISRCTN11466448 23rd November 2020.

The cost of COVID-19 vaccine delivery in Bangladesh.

COVID-19 vaccination has been instrumental in fighting the pandemic, but evidence on the actual costs associated with delivering these vaccines in resource-constrained settings has been limited. We estimated the cost of delivering COVID-19 vaccines in Bangladesh through five delivery strategies in 2021 and 2022, including Ministry of Health (MOH) hospitals, non-MOH government hospitals, outreach at Expanded Program on Immunization (EPI) centers, mass campaigns, and schools. This was a bottom-up costing study, estimating costs from a payer and beneficiary perspective. We also mapped the funding flows for COVID-19 vaccination activities and analyzed programmatic and financial challenges. The economic cost incurred by the health system to deliver COVID-19 vaccines was $1.05 per dose, excluding vaccine costs. This was made up of a financial cost of $0.29 per dose and an opportunity cost of $0.75 per dose. School-based delivery incurred the lowest financial cost of $0.27, while outreach at EPI centers incurred the highest at $0.44 per dose. The low financial cost per dose is attributed to the high daily volumes delivered at sampled sites, minimal additional resources provided to sites to implement the COVID-19 vaccination program, and a reliance on the existing workforce. Beneficiaries spent an average of $1.63 to receive a single dose of COVID-19 vaccination at fixed sites, with transport representing the largest cost driver ($0.75 per dose). The economic cost to receive one dose of the COVID-19 vaccine was $4.78. Findings can support the Government of Bangladesh to make efficient and equitable resource allocation decisions for vaccination programs.

The Economic Burden and Clinical Outcomes of Extracorporeal Membrane Oxygenation in Patients with Coronavirus Disease 2019 at the Tel Aviv Medical Center.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic posed significant challenges to healthcare systems worldwide, including a surge in the use of extracorporeal membrane oxygenation (ECMO). OBJECTIVES: To compare outcomes and costs of COVID-19 and non-COVID-19 adult patients treated with ECMO in the intensive care unit (ICU) at Tel Aviv Sourasky Medical Center. METHODS: We conducted a retrospective study. Clinical outcomes, ECMO duration, ICU and hospital length of stay (LOS), and healthcare costs were examined and compared between the two groups. RESULTS: A total of 119 patients were treated with ECMO between 2016 and 2023; 56 (47.1%) diagnosed with COVID-19. The study found no significant difference in mortality rates between COVID-19 and non-COVID-19 patients. However, COVID-19 patients experienced significantly longer ECMO durations and ICU LOS. Hospitalization and ECMO operation costs were notably higher for COVID-19 patients, but overall admission costs were lower compared to non-COVID-19 patients, with cost of surgical interventions, consultations and imaging contributing to the price gap. CONCLUSIONS: Despite longer durations of ECMO and LOS, the economic burden of ECMO in COVID-19 patients was significantly lower than non-COVID-19 patients. Strict patient selection should be utilized, a fortiori during times of surge-capacity.

Introduction of a hexavalent vaccine containing acellular pertussis into the national immunization program for infants in Peru: a cost-consequence analysis of vaccination coverage.

BACKGROUND: Infant vaccination coverage rates in Peru have declined in recent years, exacerbated by the COVID-19 pandemic. Introduction of the fully-liquid diphtheria, tetanus, and acellular pertussis (DTaP)-inactivated polio vaccine (IPV)-hepatitis B (HB)-Haemophilus influenzae type B (Hib) hexavalent vaccine (DTaP-IPV-HB-Hib) in Peru's infant National Immunization Program may help improve coverage. We evaluated costs and healthcare outcomes, including coverage, of switching from a pentavalent vaccine containing whole-cell pertussis component (DTwP-HB-Hib) plus IPV/oral polio vaccine (IPV/OPV) to the hexavalent vaccine for the primary vaccination scheme (2, 4 and 6 months). METHODS: The analysis was performed over a 5-year period on a cohort of children born in Peru in 2020 (N = 494,595). Four scenarios were considered: the pentavalent plus IPV/OPV scheme (S1); replacing the pentavalent plus IPV/OPV scheme with the hexavalent scheme (S2); expanded delivery of the pentavalent plus IPV/OPV scheme (S3); expanded delivery of the hexavalent scheme (S4). Vaccine coverage and incidence of adverse reactions (ARs) were estimated using Monte Carlo simulations and previous estimates from the literature. Cases of vaccine-preventable diseases were estimated using a Markov model. Logistical and healthcare costs associated with these outcomes were estimated. Impact of key variables (including coverage rates, incidence of ARs and vaccine prices) on costs was evaluated in sensitivity analyses. RESULTS: The overall cost from a public health payer perspective associated with the pentavalent plus IPV/OPV vaccine scheme (S1) was estimated at $56,719,350, increasing to $61,324,263 (+ 8.1%), $59,121,545 (+ 4.2%) and $64,872,734 (+ 14.4%) in scenarios S2, S3 and S4, respectively. Compared with the status quo (S1), coverage rates were estimated to increase by 3.1% points with expanded delivery alone, and by 9.4 and 14.3% points, if the hexavalent vaccine is deployed (S2 and S4, respectively). In both scenarios with the hexavalent vaccine (S2 and S4), pertussis cases would also be 5.7% and 8.7% lower, and AR rates would decrease by 32%. The cost per protected child would be reduced when the hexavalent vaccine scheme. Incidence of ARs was an important driver of cost variability in the sensitivity analysis. CONCLUSIONS: Implementation of the hexavalent vaccine in Peru's National Immunization Program has a positive public health cost consequence.

Impact of social determinants of health on hepatocellular carcinoma surveillance, treatment, and health care costs.

BACKGROUND: The impact of clinical factors and social determinants of health on treatment patterns and health care costs among patients with HCC is unknown. METHODS: Using 100% Medicare Fee-For-Service claims and a commercial multipayor claims database, we identified patients diagnosed with HCC from January 1, 2017, to December 31, 2020. Surveillance receipt was defined 12 months prior to HCC diagnosis, whereas treatment and health care costs were assessed post-HCC diagnosis. Multinomial logistic regression was used to assess the association between demographics, social determinants of health, and surveillance or HCC treatment. Multivariable generalized linear regression was used to identify factors associated with total health care costs. RESULTS: Of the 32,239 patients with HCC (mean age 68 y, 67% male, 73% White), 70% received surveillance and only half (51%) received any treatment. Curative treatment receipt was higher among those with prior surveillance (24% with CT/MRI and 18% with ultrasound vs. 9% with no surveillance). Curative treatment was independently associated with HCC surveillance and inversely associated with Black race, lower education level, and diagnosis in the year 2020 (COVID-19 year). Higher health care costs were independently associated with Black race, low English proficiency, living alone, and diagnosis in 2018-2020, and inversely associated with CT/MRI-based surveillance. CONCLUSIONS: Race and social determinants of health were independently associated with curative treatment receipt and health care costs. Increasing access to high-quality HCC surveillance may improve treatment receipt and reduce health disparities among patients with HCC.

Manpower, financial, material resources, and participation level in national fitness: a fuzzy-set QCA approach.

Background: In the era of economic globalization, major public health events-such as the Ebola epidemic, the avian influenza epidemic, the "SARS" epidemic, and the COVID-19 pandemic-occur more frequently, severely endangering human life safety and health and making global public health governance a major survival issue of universal concern. Therefore, governments have included the improvement of national health in their sustainable development goals, and its important position in global and national health policies has become increasingly prominent. However, the most common non-medical intervention taken by the government is to encourage people to actively participate in physical fitness activities to prevent disease and improve health. Therefore, how to improve the level of participation in national fitness is not only a hot topic in the academic community, but also a work content that governments around the world attach great importance to. Objectives: To reveal the complex interaction of the factors affecting the participation level in national fitness and obtain the linkage and adaptation mode of multiple conditions. Study design: Starting from the three elements of manpower, financial, material resources, combined with the characteristics of the organizational behavior of local governments in China, this study puts forward an integrated analysis framework to understand the difference of the participation level in national fitness in various provinces and regions. Methods: Fuzzy-set Qualitative Comparative Analysis (fsQCA) is used to carry out configuration analysis on the participation level in national fitness in 31 provinces and regions in China. Results: First, no single necessary condition can explain the results, whether for high-or low-level national fitness participation. Second, the construction of social sports instructors, public financial support for mass sports, and the supply of sports venues are the core conditions for improving the participation level in national fitness. Third, high-level participation of national fitness is carried out in five ways in China's provinces. Conclusion: These findings enrich the literature on improving the participation level in national fitness, and provide useful practical enlightenment for the local governments to increase the participation level in national fitness.

Assessment of the COVID-19 impact on the Brazilian Unified Health System (SUS) financing: an analysis of the financing dynamics of 2020 and 2021.

BACKGROUND: After the establishment of the public health emergency of international concern in 2020, health systems worldwide and in Brazil observed the need to apply more extraordinary logistical efforts and possibly resources to combat the imminent pandemic. METHODS: Using the historical series of public expenditures of the National Health Fund (FNS), 2015 to 2021, the number of confirmed cases of COVID-19, and a seasonal ARIMAX model, we sought to assess how the increase in the new virus infections affected the systematic financing of the SUS in Brazil. RESULTS: There were signs of seasonality and an increasing trend in the expenditure variable, which in practical terms, only indicated that the resource contributions followed an increasing trajectory already underway before the advent of the pandemic. The 1% increase in COVID-19 cases, with a one-month lag, contributes to the 0.062% increase in the variation in FNS expenditures but a decrease of 0.058% with a two-month lag. CONCLUSION: The tests showed no evidence to confirm a positive shift on FNS spending growth trajectory due to the increase of COVID-19 cases, only observing a significant increase one month after the occurrence of COVID cases, probably due to their worsening after this period, which was followed by a similar and comparable decrease in percentage of growth in the following month.

Cost-effectiveness of SARS-CoV-2 self-testing at routine gatherings to minimize community-level infections in lower-middle income countries: A mathematical modeling study.

Places of worship serve as a venue for both mass and routine gathering around the world, and therefore are associated with risk of large-scale SARS-CoV-2 transmission. However, such routine gatherings also offer an opportunity to distribute self-tests to members of the community to potentially help mitigate transmission and reduce broader community spread of SARS-CoV-2. Over the past four years, self-testing strategies have been an impactful tool for countries' response to the COVID-19 pandemic, especially early on to mitigate the spread when vaccination and treatment options were limited. We used an agent-based mathematical model to estimate the impact of various strategies of symptomatic and asymptomatic self-testing for a fixed percentage of weekly routine gatherings at places of worship on community transmission of SARS-CoV-2 in Brazil, Georgia, and Zambia. Testing strategies assessed included weekly and bi-weekly self-testing across varying levels of vaccine effectiveness, vaccine coverage, and reproductive numbers to simulate developing stages of the COVID-19 pandemic. Self-testing symptomatic people attending routine gatherings can cost-effectively reduce the spread of SARS-CoV-2 within places of worship and the community, resulting in incremental cost-effectiveness ratios of $69-$303 USD. This trend is especially true in contexts where population level attendance at such gatherings is high, demonstrating that a distribution approach is more impactful when a greater proportion of the population is reached. Asymptomatic self-testing of attendees at 100% of places of worship in a country results in the greatest percent of infections averted and is consistently cost-effective but remains costly. Budgetary needs for asymptomatic testing are expensive and likely unaffordable for lower-middle income countries (520-1550x greater than that of symptomatic testing alone), promoting that strategies to strengthen symptomatic testing should remain a higher priority.

Compounding impacts of COVID-19, cyclone and price crash on vanilla farmers' food security and natural resource use.

The intersection of the COVID-19 pandemic with other crises can amplify vulnerabilities and push communities further into poverty. In low-income countries, the dual impacts of COVID-19 and extreme weather events, along with multidimensional poverty and structural vulnerabilities in agriculture can decimate farmer livelihoods. This study aims to understand the effects of individual and compounding crises (COVID-19, cyclones, and vanilla price collapse) on smallholder vanilla farmers and local coping strategies in Madagascar, one of the world's largest vanilla producers and poorest countries. We used semi-structured and scenario-based interviews across two case study villages with contrasting enforcement of forest regulations. We found that the impact of the pandemic, combined with the cyclone event, disrupted livelihoods, resulting in income losses and food security challenges that exacerbated farmer vulnerabilities. Sixty eight percent of households reported crop losses due to strong winds and heavy rainfall brought by cyclone Enawo in 2017. The COVID-19 outbreak struck the region just as the residents were recovering from the effects of the cyclone. COVID-19-related travel restrictions in the aftermath of the cyclone took a substantial economic toll, with 54.1% of respondents experiencing a decline in earnings, and 17% facing a total loss of income due to the imposed lockdown. The decline in vanilla prices at the onset of 2020 had a far-reaching additional impact, affecting not only farmers but also residents who rely on other sources of income. Local communities reported using the forest resources more frequently as a safety net during crises in the village with more lenient regulations. This study underscores the importance of understanding the interconnectedness and compounding impacts of cascading crises on food security and natural resource use. We highlight the need for a comprehensive approach to increasing farmer resilience, particularly for those reliant on global market crops such as vanilla.

Racial and ethnic disparities in COVID-19 hospital cost of care.

INTRODUCTION: Although studies have evaluated the hospital cost of care associated with treating patients with COVID-19, there are no studies that compare the hospital cost of care among racial and ethnic groups based on detailed cost accounting data. The aims of this study were to provide a detailed description of the hospital costs of COVID-19 based on individual resources during the hospital stay and standardized costs that do not rely on inflation adjustment and evaluate the extent to which hospital total cost of care for patients with COVID-19 differs by race and ethnicity. METHODS: This study used electronic medical record data from an urban academic medical center in Chicago, Illinois USA. Hospital cost of care was calculated using accounting data representing the cost of the resources used to the hospital (i.e., cost to the hospital, not payments). A multivariable generalized linear model with a log link function and inverse gaussian distribution family was used to calculate the average marginal effect (AME) for Black, White, and Hispanic patients. A second regression model further compared Hispanic patients by preferred language (English versus Spanish). RESULTS: In our sample of 1,853 patients, the average adjusted cost of care was significantly lower for Black compared to White patients (AME = -$5,606; 95% confidence interval (CI), -$10,711 to -$501), and Hispanic patients had higher cost of care compared to White patients (AME = $8,539, 95% CI, $3,963 to $13,115). In addition, Hispanic patients who preferred Spanish had significantly higher cost than Hispanic patients who preferred English (AME = $11,866; 95% CI $5,302 to $18,431). CONCLUSION: Total cost of care takes into account both the intensity of the treatment as well as the duration of the hospital stay. Thus, policy makers and health systems can use cost of care as a proxy for severity, especially when looking at the disparities among different race and ethnicity groups.

The role of personality traits and emotional intelligence in the evaluation of the benefits and costs of social distancing during a pandemic outbreak.

The analysis of the benefits and costs of social distancing is a crucial aspect for understanding how individual and community actions can mitigate and manage the costs of a pandemic. In this study, we aimed to investigate the extent to which personality factors and emotional intelligence (EI) contributed to the subjective assessment of the benefits and costs of social distancing behaviors during the COVID-19 pandemic. We also aimed at determining whether EI served as a mediator in the relationship between personality traits and the evaluation of social distancing consequences. Data was collected via online surveys from a sample of 223 Italian-speaking participants (age: 30.78 ± 9.97; 86.1% females) between March and April 2021. Findings indicate that the tendency to prioritize the benefits of social distancing over personal costs was positively associated with emotional stability and emotion regulation, but negatively associated with extroversion. The following mediational analyses revealed that the emotion regulation facet of EI mediated the associations between personality dimensions (emotional stability and extroversion) and the evaluation of the costs and benefits of social distancing. These findings provide useful indications and implications for developing appropriate communication strategies aimed at reaching the general population and suggest that, during health-related crises, emphasis should be placed on offering courses and programs to improve and develop individuals' EI.

Consequences of Information and Communication Technologies and Environmental Degradation on Health Expenditure.

This study aims to examine how the subcomponents and overall measurement of ecological footprint, as well as the use of information and communication technologies, affect health expenditures. For this study, the sample group consisted of the top 25 countries with the highest ecological footprint for the period 2000 to 2021. System GMM estimation results demonstrate that economic growth and ecological footprint have a positive impact on health expenditures. Covid-19 dummy variables, have a statistically significant and positive effect on health expenditures. On the other hand, information and communication technologies has a statistically significant but negative effect on health expenditures. The estimation results show that the Covid-19 pandemic increased health expenditures. Looking at the effect of subcomponents of environmental degradation on health expenditures, all subcomponents have a statistically significant and positive effect on health expenditures. It is seen that the most effective variable is forest products. The variable that has almost the same impact as the footprint of forest products is the carbon footprint. Carbon footprint has significant and positive impact on health expenditures, followed by fishing grounds cropland, grazing land, built-up land. The results of the study indicate which forms of pollution should be given priority by policymakers in order to prevent an increase in health expenditure resulting from environmental degradation.

Cost Analysis of a Patient Portal Used to Remotely Monitor COVID-19 Patients in Quebec.

BACKGROUND: Telemonitoring for COVID-19 has gained much attention due to its potential in reducing morbidity, healthcare utilization, and costs. However, its benefit with regard to economic outcomes has yet to be clearly demonstrated. OBJECTIVE: To analyze the costs associated with the use of the Opal portal to monitor COVID-19 patients during their 14-day confinement in Quebec and compare them to those of non-users of any home telemonitoring technology. METHODS: A cost analysis was conducted through a cross-sectional study between COVID-19 patients who used (PU) the Opal platform during their 14-day confinement at home and those who did not use (PNU) any home remote monitoring technology. Data was collected between June 2021 to April 2022. An individual interview with each participant using an adapted questionnaire was conducted by telephone or online using a teleconferencing platform. A micro-costing approach was undertaken using a dual patient and Quebec's health-care system perspective. RESULTS: 27 telemonitoring participants, 29 non-users, 8 clinicians, and 4 managers were included. Telemonitoring reduced the average total costs incurred by PU by 82% ($537.3CAD) between PU ($117.2CAD) and PNU ($654.5CAD). Telemonitoring enrollees used healthcare less intensely with fewer emergency room visits (1 PU compared to 6 PNU), which translated to an average savings of $253.3CAD per patient. CONCLUSION: This is the first study to demonstrate that telemonitoring through the Opal platform is a viable strategy to reduce healthcare costs and utilization for patients and the healthcare system. The evidence provides strong support for introducing telemonitoring as a component of case management.

Novel cost-effective method for forecasting COVID-19 and hospital occupancy using deep learning.

The emergence of the COVID-19 pandemic in 2019 and its rapid global spread put healthcare systems around the world to the test. This crisis created an unprecedented level of stress in hospitals, exacerbating the already complex task of healthcare management. As a result, it led to a tragic increase in mortality rates and highlighted the urgent need for advanced predictive tools to support decision-making. To address these critical challenges, this research aims to develop and implement a predictive system capable of predicting pandemic evolution with accuracy (in terms of Mean Absolute error (MAE), Root Mean Square Error (RMSE), R2, and Mean Absolute Percentage Error (MAPE)) and low computational and economic cost. It uses a set of interconnected Long Short Term-memory (LSTM) with double bidirectional LSTM (BiLSTM) layers together with a novel preprocessing based on future time windows. This model accurately predicts COVID-19 cases and hospital occupancy over long periods of time using only 40% of the set to train. This results in a long-term prediction where each day we can query the cases for the next three days with very little data. The data utilized in this analysis were obtained from the "Hospital Insular" in Gran Canaria, Spain. These data describe the spread of the coronavirus disease (COVID-19) from its initial emergence in 2020 until March 29, 2022. The results show an improvement in MAE (< 161), RMSE (< 405), and MAPE (> 0.20) compared to other studies with similar conditions. This would be a powerful tool for the healthcare system, providing valuable information to decision-makers, allowing them to anticipate and strategize for possible scenarios, ultimately improving public health outcomes and optimizing the allocation of healthcare and economic resources.

Health outcomes and economic burden among patients with a COVID-19-associated hospitalization in the United States during the predominance of the XBB and JN.1 omicron lineages.

OBJECTIVE: Conduct a comprehensive analysis of the health and economic outcomes of patients with a COVID-19-associated hospitalization in the US during the predominance of the XBB and JN.1 Omicron lineages. METHODS: This analysis used data from the PINC AI Healthcare Database (PHD) for all patients with a hospital admission date occurring between February 4, 2023, and February 29, 2024 with an ICD-10-CM code U07.1 "COVID-19" in any position. The data were used to estimate the mean and median length of stay (LOS), mean and median hospitalization cost, and proportion of patients that died in the hospital, by age and level of care (normal ward, intensive care [ICU], invasive mechanical ventilation [IMV]). RESULTS: LOS, hospitalization costs, and inpatient mortality increased with both the level of care and age. Patients not receiving ICU care had the shortest LOS, lowest inpatient mortality, and lowest hospitalization costs. LOS, hospitalization costs, and inpatient mortality were higher for those receiving ICU care and highest for those receiving IMV in the ICU. Within each level of care (normal ward, ICU without IMV, and ICU with IMV), the LOS, inpatient mortality, and hospitalization cost generally increased with age, indicating that older adults with COVID-19 required a longer recovery period, have a higher likelihood of death, and accrue higher costs. However, the proportion of pediatric patients with an ICU admission and/or IMV usage remained high. LIMITATIONS: The PHD data may not be representative of all hospitalized patients in the US. CONCLUSIONS: These findings suggest that COVID-19 continues to have severe and costly consequences in all age groups, but particularly for older adults including long LOS, ICU admission, need for IMV, mortality, and high hospital costs.

Measurement of economic resilience under the COVID-19 based on nighttime light remote sensing: Case of Hubei province.

This study investigates the economic resilience of cities in Hubei province during the COVID-19 pandemic, utilizing highway nighttime lights as a proxy indicator. By February 2020, the pandemic had caused a significant economic contraction in Hubei. However, by May 2021, a strong recovery was observed, with most cities experiencing growth rates of over 20%. Despite initially similar responses to the crisis, this study reveals significant heterogeneity in economic resilience across the examined cities in Hubei. The spatial distribution follows a core-periphery structure, with Wuhan exhibiting greater resistance to economic shocks compared to peripheral cities. Furthermore, the response capacity within the Wuhan urban agglomeration area exhibits regional variations. In summary, lockdown policies had spatially varied impacts on economic resilience across Hubei's cities. These results offer valuable insights into regional economic resilience and contribute to the formulation of strategies aimed at effectively addressing future unforeseen events.

Public sector employment rigidity and macroeconomic fluctuation: A DSGE simulation for China.

Public sector employment in China has exhibited pronounced non-cyclical characteristics, with a recruiting scale and wage level showing limited responsiveness to economic fluctuations. The allure of civil service jobs in China has seen a significant resurgence post-COVID-19, with an observable increase in demand among educated job seekers for stable government positions amid growing economic uncertainties. This study investigates the implications of public sector employment rigidity on macroeconomic stability using a dynamic stochastic general equilibrium (DSGE) model integrated with search and matching (S&M) theory. Simulations incorporating alternative government job policies reveal that non-cyclical public employment exacerbates macroeconomic cyclical fluctuations. The low elasticity of public sector wages with respect to corporate wages fosters stable expectations among workers regarding the future value of government jobs, increasing the perceived value of the current state of unemployment. This leads job seekers to voluntarily remain unemployed, reducing labor supply to firms. Meantime, it preserves workers' bargaining power with firms, reinforcing wage stickiness and undermining the stabilizing role of price adjustments in employment. Hypothetical scenario analyses indicate that adopting a pro-cyclical wage policy for the public sector can mitigate the obstacles of wage cuts for firms, stimulate the creation of new jobs during economic downturns, and consequently reduce the magnitude and duration of rising unemployment rates. In contrast, maintaining a non-cyclical public sector wage may not prevent a continuous rise in unemployment or a worsening economic situation, even with expanded sector recruitment. This finding holds significant relevance in the context of the post-COVID era characterized by an economic slump and employment tension, providing theoretical support for establishing a transparent and flexible wage adjustment mechanism in the public sector that is linked to market conditions.

COVID-19 incentive payments for long-term care workers.

OBJECTIVE: Amid the COVID-19 pandemic in the Russian Federation, social care providers received incentives such as bonuses and welfare payments. The study examines the association between COVID-19 pandemic indicators and distribution of incentives to care providers in Russia. METHODS: To test the hypotheses, regression analysis is employed. RESULTS: Hypothesis H1, regarding the correlation between the COVID-19 case rate in a specific region of the Russian Federation and the actual monetary amount of bonus payments compensating for challenging working conditions of care workers in that region is supported. Hypotheses H2-H3, regarding the relationship between the COVID-19 cases/recovery rate and the monetary amount of special welfare payments to care workers distributed across the country during a given calendar month are also supported. Hypothesis H4, pertaining to the relationship between the Fiscal Year End and the monetary amount of special welfare payments distributed throughout the country to care providers during a given calendar month, is likewise supported. CONCLUSION: There is a correlation between payments to social care providers and coronavirus pandemic indicators (Tab. 5, Ref. 31). Text in PDF www.elis.sk Keywords: welfare payment, bonus, care providers.

Risk Factors for Food Insecurity among Early Childhood Education Providers: Time for a Solution.

The COVID-19 pandemic exacerbated challenges in the child care industry, leading to closures and financial strain. Early care and education (ECE) providers faced reduced income, increased debt, and material hardships such as food insecurity. Using survey data collected through the Child Care Resource Center (CCRC), this study examines the association between food insecurity risk, sociodemographic factors, and pandemic-related service changes among ECE providers in California. The results showed that income, race, and increased food costs were significantly associated with a higher risk of food insecurity among ECE providers. Compared to incomes greater than USD 60,000, those earning USD 40,000-USD 49,999 and USD 50,000-USD 59,999 had higher odds of food insecurity (OR: 1.94, 95% CI: 0.683-1.86; OR: 2.12, 95% CI: 0.623-1.81, respectively). Black (OR: 1.89, 95% CI: 1.21-2.94) and multi-racial respondents (OR: 1.71, 95% CI: 1.1-2.65) had higher odds of food insecurity than white respondents. Lastly, respondents experiencing increased food costs had greater odds of food insecurity (OR: 4.52, 95% CI: 2.74-7.45). These findings suggest the need for policies and interventions aimed at increasing food access among vulnerable ECE providers. Such interventions will better protect them from financial shocks and the risk of food insecurity, and will support their crucial role in healthy child growth and development.

Cost-effectiveness analysis of COVID-19 booster doses and oral antivirals: Case studies in the Indo-Pacific.

BACKGROUND: Decision-makers in middle-income countries need evidence on the cost-effectiveness of COVID-19 booster doses and oral antivirals to appropriately prioritise these healthcare interventions. METHODS: We used a dynamic transmission model to assess the cost-effectiveness of COVID-19 booster doses and oral antivirals in Fiji, Indonesia, Papua New Guinea, and Timor-Leste. We conducted cost-effectiveness analysis from both healthcare and societal perspectives using data collated from publicly available sources. We developed an interactive R Shiny which allows the user to vary key model assumptions, such as the choice of discounting rate, and view how these assumptions affect model results. FINDINGS: Booster doses were cost saving and therefore cost-effective in all four middle-income settings from both healthcare and societal perspectives using 3% discounting. Providing oral antivirals was cost-effective from a healthcare perspective if procured at a low generic price (US$25) or middle-income reference price (US$250); however, their cost-effectiveness was strongly influenced by rates of wastage or misuse, and the ongoing costs of care for patients hospitalised with COVID-19. The cost or wastage of rapid antigen tests did not appear strongly influential over the cost-effectiveness of oral antivirals in any of the four study settings. CONCLUSIONS: Our results support that COVID-19 booster programs are cost-effective in middle-income settings. Oral antivirals demonstrate the potential to be cost-effective if procured at or below a middle-income reference price of US$250 per schedule. Further research should quantify the rates of wastage or misuse of oral COVID-19 antivirals in middle-income settings.