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Modeling Social Distancing Strategies to Prevent SARS-CoV-2 Spread in Israel: A Cost-Effectiveness Analysis

  • Amir Shlomai
    Affiliations
    Department of Medicine D and The Liver Institute, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel and The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Ari Leshno
    Affiliations
    Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel and The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Author Footnotes
    ∗ Ella H. Sklan and Moshe Leshno contributed equally to this article.
    Ella H. Sklan
    Correspondence
    Correspondence: Ella H. Sklan, Department of Clinical Microbiology and Immunology, Sackler School of Medicine, Tel-Aviv University, Ramat Aviv, Tel Aviv, Israel 69978.
    Footnotes
    ∗ Ella H. Sklan and Moshe Leshno contributed equally to this article.
    Affiliations
    Department of Clinical Microbiology and Immunology, The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
    Search for articles by this author
  • Author Footnotes
    ∗ Ella H. Sklan and Moshe Leshno contributed equally to this article.
    Moshe Leshno
    Footnotes
    ∗ Ella H. Sklan and Moshe Leshno contributed equally to this article.
    Affiliations
    The Coller School of Management, Tel Aviv University, Tel Aviv, Israel
    Search for articles by this author
  • Author Footnotes
    ∗ Ella H. Sklan and Moshe Leshno contributed equally to this article.
Published:December 09, 2020DOI:https://doi.org/10.1016/j.jval.2020.09.013

      Highlights

      • Drastic measures of national lockdowns are taken by many countries to slow down SARS-CoV-2 spread. However, these measures have detrimental economic effects.
      • Here we compare 2 strategies to control the epidemic using a modified SEIRD model: (1) global national lockdown and (2) focused isolation of people at high exposure risk, following detailed epidemiological investigations.
      • We show that strategy 1 is modestly superior in saving lives compared to strategy 2, but with tremendous costs to prevent 1 case of death. This might result in overwhelming economic effects that are expected to increase the future death toll.

      Abstract

      Objectives

      While highly effective in preventing SARS-CoV-2 spread, national lockdowns come with an enormous economic price. Few countries have adopted an alternative “testing, tracing, and isolation” approach to selectively isolate people at high exposure risk, thereby minimizing the economic impact. To assist policy makers, we performed a cost-effectiveness analysis of these 2 strategies.

      Methods

      A modified Susceptible, Exposed, Infectious, Recovered, and Deceased (SEIRD) model was employed to assess the situation in Israel, a small country with ∼9 million people. The incremental cost-effectiveness ratio (ICER) of these strategies as well as the expected number of infected individuals and deaths were calculated.

      Results

      A nationwide lockdown is expected to save, on average, 274 (median 124, interquartile range: 71-221) lives compared to the “testing, tracing, and isolation” approach. However, the ICER will be, on average, $45 104 156 (median $49.6 million, interquartile range: 22.7-220.1) to prevent 1 case of death.

      Conclusion

      A national lockdown has a moderate advantage in saving lives with tremendous costs and possible overwhelming economic effects. These findings should assist decision makers dealing with additional waves of this pandemic.

      Keywords

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