Cost-Effectiveness and Return on Investment of Protecting Health Workers in Low- and Middle-Income Countries during the COVID-19 Pandemic

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). An investment of $3.485 billion USD would adequately protect HCWs in all LMICs. This intervention saves 789,557 (95% CI: 741,905 to 837,209) lives across LMICs, costing $418 USD per HCW case averted and $4,448 USD per HCW life saved. The societal return on investment (ROI) is $241.1 billion USD, the equivalent of a 6,918% return. Regional and national estimates are also presented. 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 production, optimization, and distribution of PPE for LMICs yields a high ROI. It is also an essential strategy to prevent widespread HCW morbidity and mortality.