26 June 2020: Since the beginning of the COVID-19 pandemic almost 10 million cases of infection have been reported. The outbreak has placed immense demands on healthcare and social systems across the world. This unprecedented strain on the world’s healthcare systems has caused severe challenges in many countries – in particular, a scarcity of equipment to both test and treat people and prevent the spread. The current crisis has forced policy makers and medical practitioners to make critical decisions regarding the allocation of resources that are scarce and costly.
Under these circumstances, cost-effectiveness analysis is a valuable tool, such as MAFEIP, to support the decision making-process. Economic evaluations are increasingly conducted alongside randomized controlled trials to provide researchers, healthcare providers, and policy makers with evidence-based results to estimate cost-effectiveness. An economic evaluation shows the overall impact, using a cost-effectiveness plane. The Incremental Cost Effectiveness Ratio (ICER) of the intervention under assessment is calculated and evaluated with the Willingness to Pay (WTP) threshold in order to facilitate decision making, see also the figure below. Various coloured zones identify the relative costliness of solutions. More specific, when an intervention is more expensive and worse than traditional treatment it will be in the red zone, while when the intervention is cheaper but worse than traditional treatment it will end up in the orange zone. When an intervention is better but more expensive than traditional treatment it will be located in the blue zone, and when an intervention is cheaper and better it will end up in the green zone.
Figure 1: A visualization of the ICER and WTP in MAFEIP
Pre-COVID ICT-solutions in healthcare delivery were either considered not more effective than traditional healthcare (in the red zone) or too costly to be implemented (in the blue zone), and therefore were deemed not cost-effective. In contrast, during the COVID-19 crisis, ICT solutions are on many occasions the only viable solution to certain problems. This reality increases the utility of the interventions, making them immediately cost-effective and dominant (in the green zone). After the pandemic is over and healthcare will presumably return to more traditional forms of healthcare provision, the challenge will be to maintain or reduce the costs of ICT solutions (e.g., through upscaling or increased efficiency) and increase their utility (show their effectiveness).
The urge to implement rapid measures to respond to COVID-19, which at the same time experienced and actively reduced core essential healthcare services, has diverted attention away from considering cost-effectiveness as part of the decision-making process when choosing an intervention. Currently, most European countries have successfully been able to “flatten the curve” of COVID-19 cases, and public health systems are slowly recovering from the extreme demands made on them. This brings new and important opportunities to evaluate both the costs and the health outcomes of COVID-19 interventions before a potential “second wave” of cases hits European Member States. The relevance of cost-effectiveness analysis in the present context is therefore high, as it enables the identification of practices that provide the greatest health outcomes while taking into account available economic resources and the scarcity of healthcare provision.
The crisis has shown that the uptake of digital solutions in healthcare has been implemented rapidly, forcing people by time pressure to save lives. Now it is time to evaluate these technologies so as to improve the efficiency of healthcare provision and enhance evidence-based healthcare deployment in the future.
Conducting a cost-effectiveness analysis, using tools such as MAFEIP, is critical in this stage of the pandemic. It will assist in better preparing countries and healthcare systems for potential next waves of infections or future pandemics. It will help in communicating and scaling-up medically impactful and cost-effective interventions.