Abstract

Dexamethasone can reduce mortality in hospitalised COVID-19 patients needing oxygen and ventilation by 18% and 36%, respectively. Here, we estimate the potential number of lives saved and life years gained if this treatment were to be rolled out in the UK and globally, as well as the cost-effectiveness of implementing this intervention. Assuming SARS-CoV-2 exposure levels of 5% to 15%, we estimate that, for the UK, approximately 12,000 (4,250 - 27,000) lives could be saved between July and December 2020. Assuming that dexamethasone has a similar effect size in settings where access to oxygen therapies is limited, this would translate into approximately 650,000 (240,000 - 1,400,000) lives saved globally over the same time period. If dexamethasone acts differently in these settings, the impact could be less than half of this value. To estimate the full potential of dexamethasone in the global fight against COVID-19, it is essential to perform clinical research in settings with limited access to oxygen and/or ventilators, for example in low- and middle-income countries.

Dexamethasone has been shown to have survival benefits for critically ill patients hospitalised with COVID-19 in the UK. Here, the authors estimated the number of lives that could be saved through a UK and global roll out of the drug and demonstrate that it is a cost-effective option.

Details

Title
Potential health and economic impacts of dexamethasone treatment for patients with COVID-19
Author
Águas Ricardo 1 ; Mahdi, Adam 2 ; Shretta Rima 3   VIAFID ORCID Logo  ; Horby, Peter 4 ; Landray Martin 5   VIAFID ORCID Logo  ; White, Lisa 3   VIAFID ORCID Logo  ; Arifi Fatima 6 ; Chynar, Zhumalieva 7 ; Lubis Inke N D 8 ; Monteiro Antoninho Benjamin 9 ; Moldokmatova Ainura 3 ; Chen Siyu 3 ; Estebesova Aida 10 ; Hussain Mofakhar 11 ; Lata Dipti 12 ; Bakare, Emmanuel A 13 ; Biniam, Getachew 14 ; Sahak, Mohammad Nadir 15 ; Phetsavanh, Chanthavilay 16 ; Nji, Akindeh M 17 ; Aung Yu Nandar 18 ; Hupert Nathaniel 19 ; Tun Sai Thein Than 1 ; Pan-Ngum Wirichada 20 ; Sarin, K C 21 ; Handoyo, Harsono 22 ; Eybpoosh Sana 23 ; Coutinho, Renato Mendes 24 ; Omoleke, Semeeh A 25 ; Amen-Patrick, Nwosu 26 ; Nantasit, Luangasanatip 20 ; Kutmanova Ainura 27 ; Aizhan, Dooronbekova 28 ; Ximenes, Antonio 29 ; Monteiro Merita 30 ; Celhay Olivier 31 ; Keyrellous, Adib 32 ; Salim, Amel H 33 ; Yunanda Yuki 34 ; Fariba Mahnaz Hossain 35 ; Amirah, Azzeri 36 ; Hancock, Penny 3 ; Hakim, Bekrizadeh 37 ; Saeedzai Sayed Ataullah 38 ; Alona Ivana 34 ; Mzumara, Grace Wezi 39 ; Martins, Joao 29 ; Herrera-Diestra, Jose L 40 ; Sharifi Hamid 41 ; Abdyldaev Talant 42 ; Jamshidi Babak 43 ; Hairi Noran Naqiah 44 ; Nasir Naima 4 ; Zaman, Rashid U 45 ; Sopuruchukwu, Obiesie 4 ; Kraenkel, Roberto A 46 ; Letchford, Nicholas 45 ; Alves Lucsendar Raimunda Fernandes 30 ; Adele, Sandra 26 ; Suárez-Idueta Lorena 47 ; Advani, Nicole 26 ; Marzouk Manar 48 ; Mabombo Viviana 26 ; Aibek, Mukambetov 49 ; Aderoba Adeniyi Kolade 4 ; Lakshmy, Tbalasubramaniam Bpriya 26 ; de Colombi Nicole Feune 4 ; Niha Maria Angela Varela 50 ; Obando, Francisco 51 ; Wattanasri Parinda 4 ; Sompob, Saralamba 20 ; Shabaruddin Fatiha 52 ; Nahin, Shimul Shafiun 53 ; Dahlui Maznah 54 ; Naidoo Reshania 4 ; Franco, Caroline 46 ; Klein, Michael G 55 ; Kubatova Aisuluu 56 ; Jabin Nusrat 26 ; Sin, Kyaw Shwe 1 ; Freitas, Luzia Tomas 4 ; Pokharel Sunil 26 ; Proochista, Ariana 4 ; Mercado, Chris Erwin, G 57 ; Ibragimov Shamil 49 ; Medina John Robert C 58 ; Mesulame, Namedre 59 

1  University of Oxford, Mahidol-Oxford Tropical Medicine Research Unit, Nuffield Department of Medicine, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948) 
2  University of Oxford, Institute of Biomedical Engineering, Department of Engineering Science, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948) 
3  University of Oxford, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948) 
4  University of Oxford, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948) 
5  Medical Research Council Population Health Research Unit at the University of Oxford, Nuffield Department of Population Health, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948) 
6  World Health Organization, Kabul, Afghanistan (GRID:grid.4991.5) 
7  Public Fund “Institution of social development” in the Kyrgyz Republic, Bishkek, Kyrgyz Republic (GRID:grid.4991.5) 
8  Universitas Sumatera Utara, Department of Paediatrics, Faculty of Medicine, Medan, Indonesia (GRID:grid.413127.2) (ISNI:0000 0001 0657 4011) 
9  Universidade da Paz, Dili, Timor-Leste (GRID:grid.449844.1) 
10  USAID Mission in the Kyrgyz Republic, Bishkek, Kyrgyz Republic (GRID:grid.4991.5) 
11  University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto, Canada (GRID:grid.17063.33) (ISNI:0000 0001 2157 2938) 
12  Oxford Policy Management, Lalitpur, Nepal (GRID:grid.17063.33) 
13  Federal University, Department of Mathematics, Oye-Ekiti, Nigeria (GRID:grid.448729.4) (ISNI:0000 0004 6023 8256) 
14  World Health Organization, Stop Transmission of Polio Program (STOP) program, Birnin Kebbi, Nigeria (GRID:grid.448729.4) 
15  World Health Organization, Kabul, Afghanistan (GRID:grid.448729.4) 
16  University of Health Sciences, Institute of Research and Education Development, Vientiane, Lao PDR (GRID:grid.412958.3) 
17  University of Yaounde, Laboratory for Public Health Research biotechnology, Biotechnology Center, Yaounde, Cameroon (GRID:grid.412661.6) (ISNI:0000 0001 2173 8504) 
18  London School of Economics, London, UK (GRID:grid.13063.37) (ISNI:0000 0001 0789 5319) 
19  Weill Cornell Medicine, and Cornell Institute for Disease and Disaster Preparedness, Cornell University, Department of Medicine, Ithaca, USA (GRID:grid.5386.8) (ISNI:000000041936877X) 
20  Faculty of Tropical Medicine, Mahidol University, Mathematical And Economic MODelling Group, Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand (GRID:grid.10223.32) (ISNI:0000 0004 1937 0490) 
21  Ministry of Public Health, Health Intervention and Technology Assessment Program (HITAP), Nonthaburi, Thailand (GRID:grid.415836.d) (ISNI:0000 0004 0576 2573) 
22  COVID-19 Task Force for North Sumatera province, Medan, Indonesia (GRID:grid.415836.d) 
23  Pasteur Institute of Iran, Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging Infectious Diseases, Tehran, Iran (GRID:grid.420169.8) (ISNI:0000 0000 9562 2611) 
24  Center for Mathematics, Computation and Cognition, Federal University of ABC, São Paulo, Brazil (GRID:grid.412368.a) (ISNI:0000 0004 0643 8839) 
25  World Health Organization, Birnin Kebbi, Nigeria (GRID:grid.412368.a) 
26  University of Oxford, Nuffield Department of Medicine, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948) 
27  Ministry of Public Health of the Kyrgyz Republic, Bishkek, Kyrgyz Republic (GRID:grid.10223.32) 
28  Public Fund “Institution of social development” in the Kyrgyz Republic, Bishkek, Kyrgyz Republic (GRID:grid.10223.32) 
29  Universidade Nacional Timor Lorosae, Dili, Timor-Leste (GRID:grid.449369.5) 
30  Charles Darwin University, Menzies School of Health Research, Darwin, Australia (GRID:grid.1043.6) (ISNI:0000 0001 2157 559X) 
31  Independent researcher (no affiliation), Ithaca, USA (GRID:grid.1043.6) 
32  University of Nottingham, Nottingham, UK (GRID:grid.4563.4) (ISNI:0000 0004 1936 8868) 
33  Population Services International, Addis Ababa, Ethiopia (GRID:grid.4563.4) 
34  Faculty of Medicine, Universitas Sumatera Utara, Department of Community Medicine, Medan, Indonesia (GRID:grid.413127.2) (ISNI:0000 0001 0657 4011) 
35  Government of People’s Republic of Bangladesh, Dhaka, Bangladesh (GRID:grid.413127.2) 
36  University of Malaya Medical Centre, Department of Research, Development and Innovation, Kuala Lumpur, Malaysia (GRID:grid.413018.f) (ISNI:0000 0000 8963 3111); Universiti Sains Islam Malaysia (USIM), Department of Primary Care, Faculty of Medicine and Health Sciences, Kuala Lumpur, Malaysia (GRID:grid.462995.5) (ISNI:0000 0001 2218 9236) 
37  Payame Noor University, Department of Statistics, Tehran, Iran (GRID:grid.412462.7) (ISNI:0000 0000 8810 3346) 
38  Ministry of Public Health, Kabul, Afghanistan (GRID:grid.490670.c) 
39  Malawi Ministry of Health, Lilongwe, Malawi (GRID:grid.415722.7) 
40  Universidad de Los Andes, Centro de Simulacion y Modelos (CeSiMo), Merida, Venezuela (GRID:grid.267525.1) (ISNI:0000 0004 1937 0853) 
41  Kerman University of Medical Sciences, HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman, Iran (GRID:grid.412105.3) (ISNI:0000 0001 2092 9755) 
42  Medical Association in the Kyrgyz Republic, Bishkek, Kyrgyz Republic (GRID:grid.412105.3) 
43  Kermanshah University of Medical Sciences, Department of Biostatistics, Kermanshah, Iran (GRID:grid.412112.5) (ISNI:0000 0001 2012 5829) 
44  University of Malaya, Kuala Lumpur, Malaysia (GRID:grid.10347.31) (ISNI:0000 0001 2308 5949) 
45  Oxford Policy Management, Oxford, UK (GRID:grid.479394.4) (ISNI:0000 0000 8881 3751) 
46  São Paulo State University (UNESP), Institute for Theoretical Physics, São Paulo, Brazil (GRID:grid.410543.7) (ISNI:0000 0001 2188 478X) 
47  University College of London, London, UK (GRID:grid.83440.3b) (ISNI:0000000121901201) 
48  Valid International Ltd, Oxford, UK (GRID:grid.487390.1) 
49  Soros Foundation in the Kyrgyz Republic, Bishkek, Kyrgyz Republic (GRID:grid.4991.5) 
50  Ministry of Health Timor-Leste, Dili, Timor-Leste (GRID:grid.4991.5) 
51  University of Oxford, PEAK Urban and Oxford Martin Informal Cities Programmes, COMPAS, School of Anthropology and Museum Ethnography, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948) 
52  University of Malaysia, Faculty of Pharmacy, Kuala Lumpur, Malaysia (GRID:grid.10347.31) (ISNI:0000 0001 2308 5949) 
53  University of Dhaka, Institute of Health Economics, Dhaka, Bangladesh (GRID:grid.8198.8) (ISNI:0000 0001 1498 6059) 
54  Faculty of Medicine, University of Malaya, Department of Social and Preventive Medicine, Kuala Lumpur, Malaysia (GRID:grid.413018.f) (ISNI:0000 0000 8963 3111) 
55  San José State University, Department of Marketing & Business Analytics, Lucas College and Graduate School of Business, San José, USA (GRID:grid.186587.5) (ISNI:0000 0001 0722 3678) 
56  Public Fund “Institution of social development” in the Kyrgyz Republic, Bishkek, Kyrgyz Republic (GRID:grid.186587.5) 
57  Independent researcher (no affiliation), Manila, Philippines (GRID:grid.4991.5) 
58  University of the Philippines Manila, Department of Epidemiology and Biostatistics, College of Public Health, Manila, Philippines (GRID:grid.11159.3d) (ISNI:0000 0000 9650 2179) 
59  Fiji Center for Disease Control (CDC), Suva, Fiji (GRID:grid.11159.3d) 
Publication year
2021
Publication date
2021
Publisher
Nature Publishing Group
e-ISSN
20411723
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1038/s41467-021-21134-2
ProQuest document ID
2556540115
Copyright
© The Author(s) 2021. corrected publication 2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.