Background

Due to the rapid spread of COVID-19, governments worldwide have implemented drastic policy measures to contain the transmission of the virus, of which have caused economic downturn and social calamity. There is paucity of data on the full economic cost (EEs) and cost-effectiveness of different policy measures currently used in containing the spread of COVID-19.

Objective

This systematic review was conducted to summarize the existing evidence on the cost and cost-effectiveness of a range of policy measures used to contain COVID-19 transmission.

Methods

Seven relevant databases and other sources were searched up to 19 March 2021. One reviewer performed searching and initial screening which were checked for the inclusion/exclusion criteria independently by another two reviewers who extracted data, and critically appraised the study quality using the Drummond 10-point checklist guidelines which were confirmed by the third reviewer.

Results

Out of 11,595 records identified, a total 31 full EEs focusing on public health interventions (PHIs) were included. Majority of studies included were in good quality and from the US. and upper-middle, and high-income countries whereas only 6 studies were from low and middle-income countries. Suppression/containment was the most deployed strategy (n=19), followed by screening/detection (n = 8), and protection (n = 4). Early adoption of effective interventions at the beginning of pandemic is essential to yield high cost-effectiveness. Adoption of a combination of strategies appears to be more effective compared to a single strategy. The trade-off between aggressive and loose suppressions depends on several factors including timing of implementation, duration, epidemiological characteristics of the virus, and the healthcare capacity.

Conclusion

Timely adoption of PHIs is essential to achieve high cost-effectiveness. Factors including timing, duration, epidemiological characteristics of the virus, and the healthcare capacity should be considered upon policy implementation. Future research should include more rigorous EEs considering societal aspect.