Allocation of scarce resources in a pandemic: rapid systematic review update of strategies for policymakers

Susanne Hempel; Rita Burke; Michael Hochman; Gina Thompson; Annie Brothers; Jennifer Shin; Aneesa Motala; Jody Larkin; Maria Bolshakova; Ning Fu; Jeanne Ringel

doi:10.1016/j.jclinepi.2021.04.021

Allocation of scarce resources in a pandemic: rapid systematic review update of strategies for policymakers

J Clin Epidemiol. 2021 Nov:139:255-263. doi: 10.1016/j.jclinepi.2021.04.021. Epub 2021 May 25.

Authors

Susanne Hempel¹, Rita Burke², Michael Hochman³, Gina Thompson⁴, Annie Brothers⁵, Jennifer Shin⁴, Aneesa Motala⁶, Jody Larkin⁷, Maria Bolshakova², Ning Fu⁸, Jeanne Ringel⁵

Affiliations

¹ Southern California Evidence Review Center, University of Southern California, 2001 N. Soto Street, 225D, Los Angeles, CA 90032; RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA. Electronic address: Susanne.Hempel@med.usc.edu.
² University of Southern California, 2001 N. Soto Street, 225B, Los Angeles, CA 90032, USA.
³ University of Southern California, 1520 San Pablos St, Los Angeles, CA 90033, USA.
⁴ Southern California Evidence Review Center, University of Southern California, 2001 N. Soto Street, Los Angeles, CA 90032, USA.
⁵ RAND Corporation, 1776 Main Street Santa Monica, CA 90401, USA.
⁶ Southern California Evidence Review Center, University of Southern California, 2001 N. Soto Street, 225D, Los Angeles, CA 90032; RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA.
⁷ RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA 15213.
⁸ Shanghai University of Finance and Economics, 318 Wuchuan Road, Wujiaochang, Yangpu District, Shanghai, China; Southern California Review Center, University of Southern California, 2001 N. Soto Street, Los Angeles, CA 90032, USA.

Abstract

Objective: In pandemics like COVID-19, the need for medical resources quickly outpaces available supply. policymakers need strategies to inform decisions about allocating scarce resources.

Study design and setting: We updated a systematic review on evidence-based approaches and searched databases through May 2020 for evaluation of strategies for policymakers.

Results: The 201 identified studies evaluated reducing demand for healthcare, optimizing existing resources, augmenting resources, and adopting crisis standards of care. Most research exists to reduce demand (n = 149); 39 higher quality studies reported benefits of contact tracing, school closures, travel restrictions, and mass vaccination. Of 28 strategies to augment resources, 6 higher quality studies reported effectiveness of establishing temporary facilities, use of volunteers, and decision support software. Of 23 strategies to optimize existing resources, 12 higher quality studies reported successful scope of work expansions and building on existing interagency agreements. Of 15 COVID-19 studies, 5 higher quality studies reported on combinations of policies and benefits of community-wide mask policies.

Conclusion: Despite the volume, the evidence base is limited; few strategies were empirically tested in robust study designs. The review provides a comprehensive overview of the effects of strategies to allocate resources and provides critical appraisal to identify the best available evidence.

Keywords: Mass casualty; Rapid review; Scarce resources; Systematic review; policymakers.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Administrative Personnel*
COVID-19 / epidemiology
Health Care Rationing / methods*
Humans
Pandemics*