Estimating the cost-of-illness associated with the COVID-19 outbreak in China from January to March 2020

Background COVID-19, an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), swept through China in 2019–2020, with over 80,000 confirmed cases reported by end of March 2020. This study estimates the economic burden of COVID-19 in 31 provincial-level administrative regions in China between January and March 2020. Methods The healthcare and societal cost of COVID-19 was estimated using bottom-up approach. The main cost components included identification, diagnosis and treatment of COVID-19, compulsory quarantine and productivity losses for all affected residents in China during the study period. Input data were obtained from government reports, clinical guidelines, and other published literature. The primary outcomes were total health and societal costs. Costs were reported in both RMB and USD (2019 value). Outcomes The total estimated healthcare and societal cost associated with the outbreak is 4.26 billion RMB (0.62 billion USD) and 2,647 billion RMB (383 billion USD), respectively. The main components of routine healthcare costs are inpatient care (41.0%) and medicines (30.9%). The main component of societal costs is productivity losses (99.8%). Hubei province incurred the highest healthcare cost (83.2%) whilst Guangdong province incurred the highest societal cost (14.6%). Interpretation This review highlights a large economic burden of the recent COVID-19 outbreak in China. These findings will aid policy makers in making informed decisions about prevention and control measures for COVID-19. Funding The author(s) received no financial support for the research, authorship, and/or publication of this article. Research in context Evidence before this study We searched MEDLINE, EMBASE and Global Health on April 4th, 2020, using key words and medical subject headings including (“coronavirus” OR “SARS-CoV-2” OR “COVID-19”) AND (“cost” OR “Economics” OR “resource” OR “productivity loss”). No restrictions on language or publication dates were applied. Our search did not identify any studies which reported the cost of COVID-19. Cost of severe acute respiratory syndrome (SARS), which is an infectious disease caused by another type of coronavirus – the SARS coronavirus – has been assessed by seven studies. The reported healthcare cost of managing SARS per case ranged from $4,151 USD in mainland China to $362,700 USD in Canada. The total healthcare cost and societal cost of the 2013 SARS outbreak in China took up 0.20% and 1.05% of China’s GDP, respectively. The global cost of SARS was estimated to be US $40 billion, the majority of which was caused by reduced consumer demand for goods and services due to fear associated with SARS. Two studies reported a reduction in total healthcare resource use during the peak of the SARS epidemic in Taiwan, due to people’s fears of SARS. Added value of this study To our knowledge, this study presents the first cost-of-illness study of COVID-19. The main cost components considered include identification, diagnosis, treatment and follow-up of COVID-19, compulsory quarantine and productivity loss for all affected residents in China during the study period. The total societal cost of COVID-19 was estimated to be 383 billion US dollars, which is equivalent to 2.7% of China’s gross domestic product (GDP) in 2019. Healthcare costs accounted for only 0.2% of societal cost for COVID-19, while productivity losses accounted for 99.8%. The majority of productivity losses (99.7%) were attributable to people who were not considered to have had COVID-19 but experienced lost working time due to the government policies in controlling population movement. Implications of all the available evidence Our findings suggest that the cost of COVID-19 is much larger than the cost of SARS or MERS. Productivity losses far exceeded the healthcare cost of managing COVID-19 patients. Future research is urgently required on the cost-effectiveness of different control measures of COVID-19 (e.g. policies regarding reducing working days, travel restrictions, quarantine and isolation), and development of interventions which can help to maintain the productivity of healthy population during the pandemic.