Table 2 Study design and setting overview

S1, S2, S3

Shlomai A, et al. [30]

Israel/ 2020

General population

1. National lockdown

2. Testing, tracing and isolation

CEA

(SEIR^d model)

NR^e

Death averted

200 days

Direct medical cost

(cost of infected individuals = isolation, hospitalization, ICU)

0% (NA^f)

One -way

The ICER value per death prevented was $45,104,156 (45,776,207.92 ^t), equivalent to $4.5 (^t$4.56) million per QALY), in national lockdown

)The ICER threshold value was estimated at around $15,243–17,366 per QALY)

S8

Zhao J, et al. [31]

China/ 2019

General population

Implementation of MRP^g:

1. No delay

2. 1-week delay,

3. 2-week delay,

4. 4-week delay,

CUA

Societal

DALY

NR

Direct and indirect cost

(average cost of hospital stay, weighted quarantine cost for all suspected cases, productivity loss)

3%

One-way and PSA^h

NMB (billion/$) for strategies1, 2, 3, and 4 was − 381 (-394.04^t), − 658 (-680.52^t), − 910 (-941.15^t), − 3,285 (-3,397.46^t), respectively

(Willingness-to-pay RMBⁱ 70,892 per averted DALY)

S7

Hagens A, et al. [32]

Turkey/ 2019

General population

1. Without vaccination

2. Vaccination (scenario1, equal effectiveness on transmission and disease (90% effectiveness) / scenario2, limited effectiveness on transmission (90% on disease and 45% on transmission))

CEA

Healthcare system

QALY

1 year

Direct and indirect cost (hospitalization costs, ICU stay, pharmacotherapy at home, vaccination, decreased productivity)

3%

Multi-way

ICER = 511 (686.20^t) $/QALY (for equal effectiveness on transmission) and 1,045 (1,403.29^t) $/QALY (for limited effectiveness on transmission)

S2, S5, S8

Wang Q, et al. [33]

China/ 2021

General population

1. Single strategy (personal protection, isolation-and-quarantine, community containment)

2. Joint strategy (personal protection and isolation-and-quarantine, personal protection and community containment^j)

3. No-intervention

CEA

Societal

Number of cases avoided

14 days

Direct and indirect cost (surgical mask, soap, water cost, direct medical cost per case, lost disposable income, quarantine cost)

NA

One-and-two-way

ICER value compared to no intervention:

Isolation-and-quarantine was still the most cost-effective single strategy (ICER = $1,278.43)

The joint strategy of personal protection and isolation-and-quarantine was the optimal choice ($1,000 per case avoided)

)ICER threshold value = $ 9,595(

S7

Wang W–C, et al. [34]

Taiwan (China) / 2021

General population

1.1.1.1.Moderna vaccination

2.2.2.2.Pfizer vaccination

3.3.3.3.AstraZeneca vaccination

4.4.4.4.No vaccination

CUA (Markov model)

Societal

QALY,

180 days

Direct medical cost and indirect cost (vaccine, treatment, productivity loss)

NA

One-way

ICUR^k per QALY ($):

Pfizer =  − 356.75

AstraZeneca =  − 341.43

Moderna =  − 321.14

)Willingness-to-pay threshold = $50,000(

S4, S6, S7

Padula WV, et al. [35]

United States/ 2020

General population

1.Do Nothing

2.Social distancing,

3.COVID-19 treatment

4. COVID-19 vaccine

CEA (Markov model)

Healthcare system

QALY

1 year

Direct medical cost and indirect cost (cost of a lost work-day, vaccine, ICU bed, hospital bed, emergency care visit (tests and x-ray), urgent care visit, (tests and x-ray), primary care visit (tests and x-ray))

3%

PSA

Budget impact of the vaccination was $40 (41.88^t) per person, making it the more affordable option (vs. $102 (106.79^t), for do nothing)

ICER ($/QALY): $16/ 0.02 = $800 (837.60^t) per QALY

)Willingness-to-pay threshold = $100,000/QALY(

S7

Kohli M,et al. [36]

United States/ 2020

General population (People over 18 years old)

1. Vaccination

2. No vaccination

CEA (Markov model)

Healthcare system

QALY

1 year

Direct medical cost (vaccine, ambulatory care only, hospitalization without ICU or ventilator, hospitalization with ICU, hospitalization with ICU + ventilator)

3%

Base case scenario and tornado diagram

ICER = $8,200 (8,585.40^t) per QALY

)Willingness-to-pay threshold = ranged from $50,000 to $150,000 per QALY gained(

S1

Jiang Y, et al. [37]

China/ 2020

COVID‐19 patients

Three versus two reverse transcription-PCR (RT-PCR) tests for diagnosing and discharging people with COVID-19

CEA

(SIR^l model)

Healthcare system

QALY

43 days

Direct medical cost (cost of RT-PCR test, cost per hospital day of the fully quarantined individuals)

5%

One-way

Net monetary benefit (as replacement for ICER) = CN¥104 million ($16.52 million^u) in 43 days

S2

Melia A, et al. [38]

Australia/ 2020

General population in 3 categories (1. Juniors

2.Adult

3.Seniors)

1. Home isolation

2. Hotel room isolation

CEA (Decision tree)

Government

Secondary household infection rate

14 days

Direct cost (ward cost, ICU cost, isolation cost at the hotel)

NA

NR

Hotel isolation vs. home isolation, in NSW^m = AU$3,000 (2,243.37^u) per person vs. AU$1054 (788.16^u) per person (NMB = AU$1,946 (1,455.19^u) per person)

Hotel isolation vs. home isolation, in WAⁿ = AU$2,520 (1,884.43^u) per person vs. 955.5 (714.15^u) per person (NMB = AU$1,564.5 (1169.91^u) per person)

S5

Risko N, et al. [39]

low- and middle-income countries/ 2020

Health workers

1. Adequate of personal protective equipment

2.Inadequate of personal protective equipment

CEA

Societal

HCW^o cases averted,

HCW death averted,

30 weeks

Direct and indirect cost (training costs, costs of labor and healthcare utilization, lost future productivity due to early mortality)

NR

Bayesian multivariate sensitivity analysis

ICER = $59 (61.01^t) per HCW case averted,

ICER = $4,309 (4,456.36^t) per HCW life saved,

S4

Thunström L, et al. [40]

United States/ 2020

General population

1. With Social distancing

2. Without social distancing

CBA

NR

VSL

30 years

Indirect cost (lost GDP^p)

3%

Break even sensitivity analysis

NMB = $5.2 (5.44^t) trillion

S1, S2

González Lopez-Valcarcel B, et al. [41]

Spain/ 2020

High-risk individuals

1.Test-tracking quarantine (TTQ) strategy

2. Do nothing

CBA

Societal

QALY

2 years

Direct and indirect cost (tests, tracers, COVID-19 cases treated at home, hospitalization (ICU, non-ICU), cost due to premature mortality and long-term morbidity consequences, lost GDP due to COVID-19 outbreak and outbreak responses)

3%

Base case sensitivity analysis

Benefit-to-cost ratio (excluding health and morbidity) = €7 (8.20^u) savings for every euro spent on TTQ

Benefit-to-cost ratio (including health and morbidity) = €19 (22.26^u) savings for every euro (1.17^u) spent on TTQ

S1, S4, S5

Losina E,et al. [42]

United States/ 2020

Undergraduate students and faculty at colleges

1.Social distancing + masks

2. Masks alone

3. laboratory screening

CEA

Societal

QALY,

Number of infections prevented

105 days

Direct cost (cost of isolation, testing and hospitalization, and NPIs (costs of running and maintaining online education platforms, masks and cleaning and disinfecting measures))

NA

Base case sensitivity analysis

ICER = $170 (177.99^t) per infection prevented,

ICER = $49,200 (51,512.4^t) per QALY saved,

S5

Bagepally BS, et al^. [43]

India/ 2019

General population

1.Surgical masks,

2.N-95 respirator (non-fit tested)

3.N-95 respirator (fit tested)

4.Hand hygiene

5.Surgical mask with hand hygiene

6. No intervention

CUA (Decision tree and Markov model)

Healthcare system

QALY

1 year

Direct cost (cost of quarantine, isolation, paracetamol, outpatient, cost of disease (mild, severe, critical), cost of surgical mask, cost of N95 respirator, cost of hand hygiene, cost of COVID-19 test)

NA

One-way

and PSA

ICER (million $/QALY):

Surgical with hand hygiene = $1.12(1.25^t)

Hand-hygiene alone = $0.113(0.12^t),

Surgical-mask alone = $1.03(1.15^t),

N- 95 respirator, fit tested = $5.65(6.33^t),

N- 95 respirator, non-fit tested = $2.98(3.34^t),

(Cost-effectiveness threshold = $1,921)

S6

Sheinson D, et al. [44]

United States/ 2020

Hospitalized patients with COVID-19 & 62.5 + years old

1. No oxygen support

2. Oxygen support with ventilation

3.Oxygen support without ventilation

CEA

(Markov model)

Societal

QALY

Lifetime

Direct and indirect cost (annual healthcare costs after discharge, productivity losses, inpatient costs (mechanical ventilation, oxygen support without ventilation, no oxygen support, mechanical ventilation bundled payment, oxygen support without ventilation bundled payment, no oxygen support bundled payment), drug costs)

3%

One-way

and PSA

ICER ($/QALY) = $8,028 (8,508.70^t) per QALY

S1

Paltiel AD, et al. [45]

United States/ 2020

General population

1.Home-based SARS-CoV-2 antigen testing,

2. No test intervention

CEA

Societal

Infection averted,

Death averted,

60 days

Direct medical cost and indirect cost (cos of tests, inpatient care, and lost workdays)

NA

NR

ICER = $7,890 (8,260.83^t) per infection averted, ICER = $1,430,000 (1,497,210^t) per death averted,

S1

Abdalhamid B, et al. [46]

United States/ 2020

Asymptomatic and symptomatic patients with COVID-19

1.RNA extraction & RT-PCR in pool testing

2.Individual testing

CEA

NR

Number of diagnosed patients

NR

Direct medical cost and indirect cost (reagents and consumables, labor)

NR

NR

ICER = $35,134 (36,785.30^t) per each diagnosed case

S1

Neilan AM, et al. [47]

United States/ 2020

General population

1. PCR for people with symptoms + no symptoms,

2. PCR only for symptoms,

CEA (Microsimulation model)

Health care system

QALY

180 days

Direct medical cost (SARS-CoV-2 PCR assay, hospital bed, ICU)

For cost: NA,

For life years lost:3%,

Multi-way and one-way

ICER = $33,000 (34,551^t) /QALY for Symptomatic + asymptomatic monthly

(Willingness-to-pay threshold = 

$100,000/QALY)

S1, S2, S4, S5

Asamoah JKK, et al. [48]

Ghana/ 2020

General population

1. The effective testing and quarantine when boarders are opened

2.Intensifying the usage of nose masks and face shields through education

3. Cleaning of surfaces with home-based detergents

4.Safety measures adopted by the asymptomatic and symptomatic individuals^q

5.Fumigating commercial areas such as markets

CEA (Deterministic model)

NR

Prevented infection cases

56 days

Direct and indirect cost (intervention costs, averted disease costs and costs of prevented cases)

NA

One-way

ICER = $7.1362^t10⁻¹² per infection averted (7.8476^t10 ^−12t)

S3

Ryan AJAaS, et al. [49]

Ireland/ 2019

People unemployed

Lockdown in 2 scenarios:

1. Generous,

2. Conservative,

CBA

Government

QALY

3 years

Direct and indirect costs (GDP deficit, government spending on healthcare)

3%

NR

Conservative policy: The total cost per QALY is €28,000 (32,489.78^u), €2 billion divided by 71,428 QALYs

Generous policy: The total cost per QALY is €15,555 (18,049.23^u), €1 billion divided by 64,285 QALYs)

)The costs of lockdown are 25 times greater than its benefits(

S6

Águas R, et al. [50]

United Kingdom/ 2020

Hospitalized COVID‐19 patients needing oxygen and ventilation

1.Medication with dexamethasone, if patient has criteria for this treatment

2.No-Medication with dexamethasone

CEA

Health care provider

QALY

6 months

Direct medical cost (daily hospital patient costs per treatment)

NA

NR

ICER < £20,000 (27,768.56^u) per quality-adjusted life-year (QALY)

England has an explicit threshold range of £20,000–£30,000

S3

Rowthorn R, et al. [51]

United Kingdom/ 2020

General population

1.Do nothing

2.Lockdown

CBA (SIR model)

Governments

Deaths

1 week

Direct medical cost and indirect cost (treatment, loss of output(production))

NA

NR

ICER = £2 (2.77^u) million to each fatality

)A 10-week lockdown is only optimal if the value of life for COVID-19 victims exceeds £10 m.(

S1, S2

Paltiel AD, et al. [52]

United States/ 2020

College students

1.Screening (every 2 days) and isolation program,

2.Screening (daily) and isolation program,

3.Screening (weekly) and isolation program,

CEA

Societal

Infectious case prevented

80 days

Direct medical cost (equipment and personnel costs)

NA

NR

ICER = $7900 (8271.30^t) per infected averted,

(Willingness-to-pay = $100,000(

S3, S8

Broughel J, et al. [53]

United States/ 2020

General population

1.No intervention

2. State suppression policies (stay-at-home; closing nonessential businesses, public schools, higher educational and facilities; severe travel restrictions)

CBA

Societal

QALY

NR

Direct and indirect cost (lost income, costs of suppression measures, hospitalization, ICU admission, mechanical ventilation)

5%

NR

Gross mortality benefits using the “value-of-production” approach:

Net benefit, low = $285.3 billion (298.70^t)

Net benefit, high = $368.3 billion (385.61^t)

(The monetary threshold per QALY (gross mortality benefits): between $285 billion and $530 billion)

S6

Gandjour AJm,et al. [54]

Germany/ 2020

COVID‐19 patients

1.No intervention

2.Provision of additional capacity (ICU bed)

CEA

Societal

Life year gained

Lifetime

Direct medical cost (initial stay in ICU, rehospitalization)

3% for costs

&

1% for health benefits

One‐way

ICER = €24,815 (29,109.55^u) per life year gained

(ICER of an additional ICU bed was €24,815 per life year gained)

(The willingness to pay = €101,493 per life year gained)

S4

Schonberger RB, et al. [55]

United States/ 2020

General population

1.Strategy of full reopening aimed at achieving herd immunity

2.Strategy of limited reopening with social distancing

CBA

NR

QALY

8 months

Indirect cost (plausible effects of economic cost on US GDP)

3%

NR

ICER = $125,000 (130,875^t) per QALY

S7

Sandmann, F.G [56]

United Kingdom/ 2020

General population (individuals aged 20 years or older)

1.Vaccination (best-case scenario, worst-case scenario),

2.No vaccination

CBA

(A dynamic modelling framework)

Health system

QALY

10 years

Direct and indirect cost (hospital admissions (ICU, non-ICU), personal protective equipment, visits to general practitioners, remote helpline calls, adverse events following immunisation, vaccine administrations, vaccine costs, conservative long-run cost per vaccine dose)

3·5%

PSA

Incremental net monetary values ranging from £12 (16.66^u) billion to £334·7(464.70^u) billion in the best-case scenario; And, from –£1·1 (1.52^u) billion to £56·9 (79.00^u) billion in the worst-case scenario

(Monetary value threshold per QALY = £20,000)

S3

Dutta M, Husain Z [57]

India/ 2020

General population

1.lockdown under 3 alternative scenarios (growth in income: 6%,7%, and 8%)

CBA

Health system

Cases avoided,

Deaths averted

14 days

Direct and indirect cost (homecare,

hospitalization, ICU admission, unemployment, loss in production)

4%

NR

Under all the scenarios:

Net benefits < 0

S5

Kazungu J,et al. [58]

Kenya/ 2020

Healthcare workers

1. Adequate/full PPE utilization

2. Inadequate supply of PPE

CEA

Government

Death averted,

COVID-19 case averted,

1 year

Direct and indirect cost (cost of training (nurse, clinical officer), cost per nurse-day of work, hospital bed, lost GDP per capita)

NA

PSA

Cost per COVID-19 case averted = $51 (54.11^t)

Cost per death averted = $ 371 (393.66^t)

(Willingness to pay = $517)

S6

Chow R,et al. [59]

United States/ 2020

Hospitalized COVID-19 patients

1.Statin use

2.No statin use

CEA

Healthcare system

Discharged; Death; Toxicity

4 weeks

Direct medical cost (hospitalization (ICU, non-ICU), Statin)

NA

NR

ICER < 0

The mean cost for patients receiving statins was $31,623 (33,109.28^t), whereas the mean cost for patients not receiving statins was $33,218(34,779.24^t), The mean effectiveness for the two cohorts were 1.73 and 1.71, respectively

S6

Jo Y,et al. [60]

South Africa/ 2020

Hospitalized COVID-19 patients in ICU

1.Administration of dexamethasone to ventilated patients and Remdesivir to non-ventilated patients,

2.Dexamethasone alone to both non-ventilated and ventilated patients,

3.Remdesivir to no ventilated patients only,

4.Dexamethasone to ventilated patients only

5. All relative to a scenario of standard care

CEA

Healthcare system

Deaths averted

6 months

Direct medical cost (cost of Remdesivir regimen, cost of dexamethasone regimen, ICU)

5%

One-way and three-way sensitivity analyses

ICER = $231 (241.64^t) per death averted

S6

Jiang Y,et al. [61]

China/ 2020

Severe COVID-19 patients

1.Remdesivir regimen

2.Standard of care

CEA

Healthcare system

QALY

3 months

Direct medical cost (RT-PCR test fee for diagnosis and discharge of all infected and symptomatic persons, 1-time outpatient costs of mild patients, bed costs of mild patients during quarantine, hospitalization costs of moderate patients, hospitalization costs of severe patients, SoC^r medication costs of moderate patients, SoC medication costs of severe patients, and Remdesivir acquisition costs)

5%

One-way

and PSA

ICER = CN¥ 14,098 (2,239.86^u) per QALY

S6

Congly SE, et al. [62]

United States/ 2020

COVID-19 patients

1.Remdesivir to all patients,

2.Remdesivir in only moderate and only severe infections,

3.Dexamethasone to all patients,

4.Dexamethasone in severe infections,

5.Remdesivir in moderate/dexamethasone in severe infections,

CUA

Payer

QALY

1 year

Direct medical cost (supportive care)

NA

PSA

ICER = $980.84 (1026.93^t) per QALY

(Willingness to pay threshold = $100,000/QALY)

S2, S3, S4, S5, S8

Lally M [63]

New Zealand/ 2021

General population

1.Lockdown strategy

2. Mitigation strategy (including case isolation, quarantining of members of their households, limiting large gatherings, social distancing, the wearing of masks on public transport, and restrictions targeted at only high-risk groups)

CBA

NR

QALY

4 months

Indirect cost (GDP Losses)

3.5%

NR

lockdown: Cost per QALY saved = at least $924,000 (960,405.60^t)

(A threshold figure of $62,000 for health interventions in New Zealand)

S1, S2, S3, S6

Raitzer D,et al. [64]

Philippines/ 2020

Students

1.Increased tracing- testing-and isolation TTQ

2.Paid sick leave (in cases with a positive diagnosis for treatment)

3.School face-to-face closure (in 3 scenarios: for all; for 15 + year old; for under 15-year old)

CBA

NR

Reduced disease burden of covid-19, Reduced cost of treatment, Life saved

Lifetime

Direct and indirect cost (labor force to care for children at home, lost income, lost productivity caused by poor training, employment of private school teachers)

Less than 3%

NR

Benefit–cost ratio (policy1:1.20,

policy2: 10, policy3: 0.011)

(₱768 (15.65^u) million per life saved for closure at all levels, ₱366 (7.45^u) million per life saved from closure for 15 + year old, and ₱1.38 (0.02^u) billion per life saved from closure for those under 15 years of age)

(Willingness to pay = ₱10,000)

S1

Seguí FL,et al. [65]

Spain/ 2020

General population

Mass COVID-19 screenings of an asymptomatic population (Scenario1: PCR test & scenario2: RAT^s)

CBA

Societal

Monetary value of a QALY

5 months

Direct medical cost (hospitalization, ICU admission)

3%

NR

Benefit–cost ratio:

Base case = 1.20, RAT = 1.63; PCR = 1.23

(Monetary value of a QALY: €25,000)