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      The Potential Health Care Costs And Resource Use Associated With COVID-19 In The United States : A simulation estimate of the direct medical costs and health care resource use associated with COVID-19 infections in the United States.

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          Abstract

          With the coronavirus disease 2019 (COVID-19) pandemic, one of the major concerns is the direct medical cost and resource use burden imposed on the US health care system. We developed a Monte Carlo simulation model that represented the US population and what could happen to each person who got infected. We estimated resource use and direct medical costs per symptomatic infection and at the national level, with various "attack rates" (infection rates), to understand the potential economic benefits of reducing the burden of the disease. A single symptomatic COVID-19 case could incur a median direct medical cost of $3,045 during the course of the infection alone. If 80 percent of the US population were to get infected, the result could be a median of 44.6 million hospitalizations, 10.7 million intensive care unit (ICU) admissions, 6.5 million patients requiring a ventilator, 249.5 million hospital bed days, and $654.0 billion in direct medical costs over the course of the pandemic. If 20 percent of the US population were to get infected, there could be a median of 11.2 million hospitalizations, 2.7 million ICU admissions, 1.6 million patients requiring a ventilator, 62.3 million hospital bed days, and $163.4 billion in direct medical costs over the course of the pandemic.

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          Most cited references20

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          Respiratory syncytial virus pneumonia among the elderly: an assessment of disease burden.

          Respiratory syncytial virus (RSV) is an important cause of acute lower respiratory tract disease among the elderly, but national estimates of the burden of this disease have not been made. To estimate the morbidity, mortality, and medical costs of RSV-associated pneumonia among US elderly, national hospital discharge data, vital statistics, etiologic studies of adult pneumonia hospitalizations, and Medicare cost data were reviewed. In the United States, 687,000 hospitalizations and 74,000 deaths caused by pneumonia occur annually among the elderly; approximately 2%-9% of these are caused by RSV. At a cost of $11,000 per RSV pneumonia hospitalization, the estimated annual cost of RSV pneumonia hospitalizations is $150-$680 million. Exacerbations of congestive heart failure and other chronic conditions may also contribute substantially to RSV disease burden among the elderly. The total RSV disease burden is probably great enough to justify development of an RSV vaccine for use in this group.
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            The role of subway travel in an influenza epidemic: a New York City simulation.

            The interactions of people using public transportation in large metropolitan areas may help spread an influenza epidemic. An agent-based model computer simulation of New York City's (NYC's) five boroughs was developed that incorporated subway ridership into a Susceptible-Exposed-Infected-Recovered disease model framework. The model contains a total of 7,847,465 virtual people. Each person resides in one of the five boroughs of NYC and has a set of socio-demographic characteristics and daily behaviors that include age, sex, employment status, income, occupation, and household location and membership. The model simulates the interactions of subway riders with their workplaces, schools, households, and community activities. It was calibrated using historical data from the 1957-1958 influenza pandemics and from NYC travel surveys. The surveys were necessary to enable inclusion of subway riders into the model. The model results estimate that if influenza did occur in NYC with the characteristics of the 1957-1958 pandemic, 4% of transmissions would occur on the subway. This suggests that interventions targeted at subway riders would be relatively ineffective in containing the epidemic. A number of hypothetical examples demonstrate this feature. This information could prove useful to public health officials planning responses to epidemics.
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              There remains substantial debate over the impact of school closure as a mitigation strategy during an influenza pandemic. The ongoing 2009 H1N1 influenza pandemic has provided an unparalleled opportunity to test interventions with the most up-to-date simulations.
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                Author and article information

                Journal
                Health Affairs
                Health Affairs
                Health Affairs (Project Hope)
                0278-2715
                1544-5208
                April 23 2020
                : 10.1377/hlthaff
                Affiliations
                [1 ]Sarah M. Bartsch is a project director at Public Health Informatics, Computational and Operations Research (PHICOR), City University of New York, in New York City.
                [2 ]Marie C. Ferguson is a project director at PHICOR, City University of New York.
                [3 ]James A. McKinnell is an associate professor of medicine in the Infectious Disease Clinical Outcomes Research Unit, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, in Los Angeles, California.
                [4 ]Kelly J. O’Shea is a senior research analyst at PHICOR, City University of New York.
                [5 ]Patrick T. Wedlock is a senior research analyst at PHICOR, City University of New York.
                [6 ]Sheryl S. Siegmund is director of operations at PHICOR, City University of New York.
                [7 ]Bruce Y. Lee () is a professor of health policy and management and executive director of PHICOR, City University of New York.
                Article
                10.1377/hlthaff.2020.00426
                32324428
                dcf873bd-78d6-46d2-a142-8b909b38162c
                © 2020
                History

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