Cost-effectiveness and return on investment of protecting health workers in low- and middle-income countries during the COVID-19 pandemic
Open accessPublished version of a preprint
Abstract
BACKGROUND: In this paper, we predict the health and economic consequences of immediate investment in personal protective equipment (PPE) for health care workers (HCWs) in low- and middle-income countries (LMICs). METHODS: To account for health consequences, we estimated mortality for HCWs and present a cost-effectiveness and return on investment (ROI) analysis using a decision-analytic model with Bayesian multivariate sensitivity analysis and Monte Carlo simulation. Data sources included inputs from the World Health Organization Essential Supplies Forecasting Tool and the Imperial College of London epidemiologic model. RESULTS: An investment of $9.6 billion USD would adequately protect HCWs in all LMICs. This intervention would save 2,299,543 lives across LMICs, costing $59 USD per HCW case averted and $4,309 USD per HCW life saved. The societal ROI would be $755.3 billion USD, the equivalent of a 7,932% return. Regional and national estimates are also presented. DISCUSSION: In scenarios where PPE remains scarce, 70-100% of HCWs will get infected, irrespective of nationwide social distancing policies. Maintaining HCW infection rates below 10% and mortality below 1% requires inclusion of a PPE scale-up strategy as part of the pandemic response. In conclusion, wide-scale procurement and distribution of PPE for LMICs is an essential strategy to prevent widespread HCW morbidity and mortality. It is cost-effective and yields a large downstream return on investment.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Wang, D., Hu, B., Hu, C., Zhu, F., Liu, X., Zhang, J., Wang, B., Xiang, H., Cheng, Z., Xiong, Y., et al. (2020) · JAMA · doi:10.1001/jama.2020.1585 · Cited by 20,148 · see citing works
Lai, J., Ma, S., Wang, Y., Cai, Z., Hu, J., Wei, N., Wu, J., Du, H., Chen, T., Li, R., et al. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.3976 · Cited by 8,015 · see citing works
Chu, D. K., Akl, E. A., Duda, S., Solo, K., Yaacoub, S., Schünemann, H. J., Chu, D. K., Akl, E. A., El-harakeh, A., Bognanni, A., et al. (2020) · The Lancet · doi:10.1016/s0140-6736(20)31142-9 · Cited by 3,843 · see citing works
Sanders, G. D., Neumann, P. J., Basu, A., Brock, D. W., Feeny, D., Krahn, M., Kuntz, K. M., Meltzer, D. O., Owens, D. K., Prosser, L. A., et al. (2016) · JAMA · doi:10.1001/jama.2016.12195 · Cited by 3,069 · see citing works
Ranney, M. L., Griffeth, V., & Jha, A. K. (2020) · New England Journal of Medicine · doi:10.1056/nejmp2006141 · Cited by 2,018 · see citing works
Husereau, D., Drummond, M., Petrou, S., Carswell, C., Moher, D., Greenberg, D., Augustovski, F., Briggs, A. H., Mauskopf, J., & Loder, E. (2013) · Value in Health · doi:10.1016/j.jval.2013.02.002 · Cited by 1,998 · see citing works
Managing COVID-19 in Low- and Middle-Income Countries
Hopman, J., Allegranzi, B., & Mehtar, S. (2020) · JAMA · doi:10.1001/jama.2020.4169 · Cited by 545 · see citing works
Cheng, V. C., Wong, S., Chen, J. H.-K., Yip, C. C., Chuang, V. W., Tsang, O. T. Y., Sridhar, S., Chan, J. F., Ho, P., & Yuen, K. (2020) · Infection Control and Hospital Epidemiology · doi:10.1017/ice.2020.58 · Cited by 468 · see citing works
den Bergh, M. K.-V., Buiting, A. G. M., Pas, S. D., Bentvelsen, R. G., van den Bijllaardt, W., van Oudheusden, A. J. G., van Rijen, M. M. L., Verweij, J. J., Koopmans, M., & Kluytmans, J. A. J. W. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.9673 · Cited by 372 · see citing works
Correlation Between N95 Extended Use and Reuse and Fit Failure in an Emergency Department
Degesys, N. F., Wang, R. C., Kwan, E., et al. (2020) · JAMA · doi:10.1001/jama.2020.9843 · Cited by 90 · see citing works
Kentikelenis, A., Gabor, D., Ortiz, I., Stubbs, T., McKee, M., & Stückler, D. (2020) · The Lancet Global Health · doi:10.1016/s2214-109x(20)30135-2 · Cited by 60 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
The Lancet Commission on lessons for the future from the COVID-19 pandemic
Sachs, J. D., Karim, S. S. A., Aknin, L., Allen, J., Brosbøl, K., Colombo, F., Barron, G. C., Espinosa, M. F., Gaspar, V., Gaviria, A., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(22)01585-9 · Cited by 842 · see citing works
- Authors
- Risko, N., Werner, K., Offorjebe, O. A., Vecino-Ortiz, A. I., Wallis, L. A., & Razzak, J.
- Affiliations
- Johns Hopkins University (US)
- University of Cape Town (ZA)
- University of Southern California (US)
- Corresponding author
- Risko, Nicholas
- ORCID
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2020-10-09
- Volume
- 15
- Issue
- 10
- Pages
- e0240503
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC7546502
- OpenAlex
- W3091870652
- Cited by
- 45
- References
- 11
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 4 · 2023: 8 · 2022: 10 · 2021: 14 · 2020: 4
- FWCI
- 7.65
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- medRxiv (acceptedVersion, cc-by-nc-nd)
- SSRN Electronic Journal (acceptedVersion)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Informationszentrum Lebenswissenschaften (ZB MED) (submittedVersion, cc-by)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Infection Control and Ventilation
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Keywords
- personal protective equipment, healthcare workers, COVID-19 pandemic, low- and middle-income countries, cost-effectiveness, return on investment, social distancing, pandemic response, economic burden of infection
- MeSH terms
- Personal Protective Equipment, Betacoronavirus, COVID-19, SARS-CoV-2, Bayes Theorem, Cost-Benefit Analysis, Developing Countries, Health Workforce, Health Personnel, Humans, Monte Carlo Method, Pneumonia, Viral, Coronavirus Infections, Pandemics
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
