Cost-effectiveness of mask mandates on subways to prevent SARS-CoV-2 transmission in the United States

Community-based mask wearing has been shown to reduce the transmission of SARS-CoV-2. However, few studies have conducted an economic evaluation of mask mandates, specifically in public transportation settings. This study evaluated the cost-effectiveness of implementing mask mandates for subway pass...

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Bibliographic Details
Published in:PloS one Vol. 19; no. 5; p. e0302199
Main Authors: Park, Joohyun, Joo, Heesoo, Kim, Daniel, Mase, Sundari, Christensen, Deborah, Maskery, Brian A.
Format: Journal Article
Language:English
Published: United States Public Library of Science 15.05.2024
Public Library of Science (PLoS)
Subjects:
Biology and life sciences
Comparative analysis
Control
Cost analysis
Cost control
Cost reduction
Cost-Benefit Analysis
COVID-19
COVID-19 - economics
COVID-19 - epidemiology
COVID-19 - prevention & control
COVID-19 - transmission
Death
Disease control
Disease transmission
Economic aspects
Economics
Effectiveness
Engineering and Technology
Epidemics
Estimates
Evaluation
Fatalities
Health aspects
Health care expenditures
Hospitalization
Humans
Infection
Infections
Intervention
Laws, regulations and rules
Local transit
Market prices
Masks
Masks - economics
Medical care, Cost of
Medical policy
Medical research
Medicine and Health Sciences
Medicine, Experimental
Mortality
Opportunity costs
Pandemics
People and places
Prevention
Public transportation
Respiratory diseases
Risk factors
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2
Social Sciences
Subways
Transportation - economics
Travel
Travel - economics
United States
United States - epidemiology
Viral diseases
United States
United States > US
ISSN:1932-6203, 1932-6203
Online Access:Get full text
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Summary:Community-based mask wearing has been shown to reduce the transmission of SARS-CoV-2. However, few studies have conducted an economic evaluation of mask mandates, specifically in public transportation settings. This study evaluated the cost-effectiveness of implementing mask mandates for subway passengers in the United States by evaluating its potential to reduce COVID-19 transmission during subway travel. We assessed the health impacts and costs of subway mask mandates compared to mask recommendations based on the number of infections that would occur during subway travel in the U.S. Using a combined box and Wells-Riley infection model, we estimated monthly infections, hospitalizations, and deaths averted under a mask mandate scenario as compared to a mask recommendation scenario. The analysis included costs of implementing mask mandates and COVID-19 treatment from a limited societal perspective. The cost-effectiveness (net cost per averted death) of mandates was estimated for three different periods based on dominant SARS-CoV-2 variants: Alpha, Beta, and Gamma (November 2020 to February 2021); Delta (July to October 2021); and early Omicron (January to March 2022). Compared with mask recommendations only, mask mandates were cost-effective across all periods, with costs per averted death less than a threshold of $11.4 million (ranging from cost-saving to $3 million per averted death). Additionally, mask mandates were more cost-effective during the early Omicron period than the other two periods and were cost saving in January 2022. Our findings showed that mandates remained cost-effective when accounting for uncertainties in input parameters (e.g., even if mandates only resulted in small increases in mask usage by subway ridership). The findings highlight the economic value of mask mandates on subways, particularly during high virus transmissibility periods, during the COVID-19 pandemic. This study may inform stakeholders on mask mandate decisions during future outbreaks of novel viral respiratory diseases.
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Competing Interests: The authors have declared that no competing interests exist.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0302199