RESUMO
BACKGROUND: During the COVID-19 pandemic, Test-Trace-Isolate (TTI) programs have been recommended as a risk mitigation strategy. However, many governments have hesitated to implement them due to their costs. This study aims to estimate the cost-effectiveness of implementing a national TTI program to reduce the number of severe and fatal cases of COVID-19 in Colombia. METHODS: We developed a Markov simulation model of COVID-19 infection combined with a Susceptible-Infected-Recovered structure. We estimated the incremental cost-effectiveness of a comprehensive TTI strategy compared to no intervention over a one-year horizon, from both the health system and the societal perspective. Hospitalization and mortality rates were retrieved from Colombian surveillance data. We included program costs of TTI intervention, health services utilization, PCR diagnosis test, productivity loss, and government social program costs. We used the number of deaths and quality-adjusted life years (QALYs) as health outcomes. Sensitivity analyses were performed. FINDINGS: Compared with no intervention, the TTI strategy reduces COVID-19 mortality by 67%. In addition, the program saves an average of $1,045 and $850 per case when observed from the social and the health system perspective, respectively. These savings are equivalent to two times the current health expenditures in Colombia per year. INTERPRETATION: The TTI program is a highly cost-effective public health intervention to reduce the burden of COVID-19 in Colombia. TTI programs depend on their successful and speedy implementation. FUNDING: This study was supported by the Colombian Ministry of Health through award number PUJ-04519-20 received by EPQ AVO and SDS declined to receive any funding support for this study. The contents are the responsibility of all the individual authors.
RESUMO
Se estimó la carga de enfermedad en el IMSS en el año 2000. Resultados: similitud con subregión AMRO A y Australia en primeros diagnósticos, AVISAS Totales y APMP; mayor semejanza en AVD con subregiones AMRO B y D; esperanzas de vida totales similares a subregión AMRO A; esperanzas de vida con discapacidad semejantes a subregiones AMRO B y D; en entidades federativas, a mayor desarrollo socioeconómico, mayor AVD y esperanzas de vidas con discapacidad y menor APMP. Conclusión: Los afiliados al IMSS acumulan una carga de morbilidad mayor a lo esperado y en entidades federativas se asocia directamente con el desarrollo socioeconómico. Se infiere que, en el 2000, los afiliados al IMSS experimentaban baja mortalidad con expansión de morbilidad.
The burden of disease was estimated in people affiliated to the Mexican Social Insurance Institute -IMSS- in 2000.Main results: Similarities with AMRO A subregion and Australia in first causes of burden, total DALY and years lost due to premature mortality; similarities withAMRO B and D subregions in disability live expectancy; highest socioeconomic development associated with highest magnitude of years lived with disability and disability live expectancyat federative entities level. Conclusion: An unexpective high burden of morbidity with disability was found in people affiliated to IMSS; in federative entities, the burden of morbidity is associatedwith socioeconomic level. These results permit to infer, ecologically, that this population is experimented low levels of mortality with an expansion of morbidity.
Estimou-se a carga de doença no IMSS em 2000. Resultados: semelhanças com sub-região AMRO A e Austrália nos primeiros diagnósticos, AVISAS Totais e APMP; maior semelhança em AVD com sub-regiões AMRO B e D; expectativa de vida total similar a sub-região AMROA; expectativa de vida com deficiência semelhantes às sub-regiões AMRO B e D; em entidades federativas, quanto maior desenvolvimento socioeconômico, maior AVD e expectativa de vidas com deficiência e menor APMP. Conclusão: Os filiados ao IMSS acumulam una cargade morbilidade superior à esperada e em entidades federativas associa-se diretamente com o desenvolvimento socioeconômico. Infere-se que, em 2000, os filiados ao IMSS experimentavam baixa mortalidade com expansão de morbilidade.
