To estimate the economic cost of coronavirus disease 19 (COVID-19) in 31 provincial-level administrative regions and in total, in China. We used data from government reports, clinical guidelines and other publications to estimate the main cost components of COVID-19 during 1 January–31 March 2020. These components were: identification and diagnosis of close contacts; suspected cases and confirmed cases of COVID-19; treatment of COVID-19 cases; compulsory quarantine of close contacts and suspected cases; and productivity losses for all affected residents. Primary outcomes were total health-care and societal costs. The total estimated health-care and societal costs associated with COVID-19 were 4.26 billion Chinese yuan (¥; 0.62 billion United States dollars, US$) and ¥ 2646.70 billion (US$ 383.02 billion), respectively. Inpatient care accounted for 44.2% (¥ 0.95 billion/¥ 2.15 billion) of routine health-care costs followed by medicines, accounting for 32.5% (¥ 0.70 billion/¥ 2.15 billion). Productivity losses accounted for 99.8% (¥ 2641.61 billion/¥ 2646.70 billion) of societal costs, which were mostly attributable to the effect of movement-restriction policies on people who did not have COVID-19. Societal costs were most sensitive to salary costs and number of working days lost due to movement-restriction policies. Hubei province had the highest health-care cost while Guangdong province had the highest societal cost. Our results highlight the high economic burden of the COVID-19 outbreak in China. The control measures to prevent the spread of disease resulted in substantial costs from productivity losses amounting to 2.7% (US$ 382.29 billion/US$ 14.14 trillion) of China’s annual gross domestic product.

[¹⁸F]FDOPA PET imaging has shown dopaminergic function indexed asK_i^cerdiffers between antipsychotic treatment responders and non-responders. However, the theragnostic potential of this biomarker to identify non-responders has yet to be evaluated. In view of this, we aimed to evaluate this as a theragnostic test using linear and non-linear machine-learning (i.e., Bernoulli, support vector, random forest and Gaussian processes) analyses and to develop and evaluate a simplified approach, standardised uptake value ratio (SUVRc). Both [¹⁸F]FDOPA PET approaches had good test-rest reproducibility across striatal regions (K_i^cerICC: 0.68–0.94, SUVRc ICC: 0.76–0.91). Both our linear and non-linear classification models showed good predictive power to distinguish responders from non-responders (receiver operating curve area under the curve for region-of-interest approach:K_i^cer = 0.80, SUVRc = 0.79; for voxel-wise approach using a linear support vector machine: 0.88) and similar sensitivity for identifying treatment non-responders with 100% specificity (K_i^cer: ~50%, SUVRc: 40–60%). Although the findings were replicated in two independent datasets, given the total sample size (n = 84) and single setting, they warrant testing in other samples and settings. Preliminary economic analysis of [¹⁸F]FDOPA PET to fast-track treatment-resistant patients with schizophrenia to clozapine indicated a potential healthcare cost saving of ~£3400 (equivalent to $4232 USD) per patient. These findings indicate [¹⁸F]FDOPA PET dopamine imaging has potential as biomarker to guide treatment choice.

General practitioners are usually the first health professionals to be contacted by people with early signs of psychosis. We aimed to assess whether increased liaison between primary and secondary care improves the clinical effectiveness and cost-effectiveness of detection of people with, or at high risk of developing, a first psychotic illness. Our Liaison and Education in General Practices (LEGs) study was a cluster-randomised controlled trial of primary care practices (clusters) in Cambridgeshire and Peterborough, UK. Consenting practices were randomly allocated (1:1) to a 2 year low-intensity intervention (a postal campaign, consisting of biannual guidelines to help identify and refer individuals with early signs of psychosis) or a high-intensity intervention, which additionally included a specialist mental health professional who liaised with every practice and a theory-based educational package. Practices were not masked to group allocation. Practices that did not consent to be randomly assigned comprised a practice-as-usual (PAU) group. The primary outcome was number of referrals of patients at high risk of developing psychosis to the early intervention service per practice site. New referrals were assessed clinically and stratified into those who met criteria for high risk or first-episode psychotic illness (FEP; together: psychosis true positives), and those who did not fulfil such criteria for psychosis (false positives). Referrals from PAU practices were also analysed. We assessed cost-effectiveness with decision analytic modelling in terms of the incremental cost per additional true positive identified. The trial is registered at the ISRCTN registry, number ISRCTN70185866. Between Dec 22, 2009, and Sept 7, 2010, 54 of 104 eligible practices provided consent and between Feb 16, 2010, and Feb 11, 2011, these practices were randomly allocated to interventions (28 to low intensity and 26 to high intensity); the remaining 50 practices comprised the PAU group. Two high-intensity practices were excluded from the analysis. In the 2 year intervention period, high-intensity practices referred more FEP cases than did low-intensity practices (mean 1.25 [SD 1.2] for high intensity vs 0.7 [0.9] for low intensity; incidence rate ratio [IRR] 1.9, 95% CI 1.05-3.4, p=0.04), although the difference was not statistically significant for individuals at high risk of psychosis (0.9 [1.0] vs 0.5 [1.0]; 2.2, 0.9-5.1, p=0.08). For high risk and FEP combined, high-intensity practices referred both more true-positive (2.2 [1.7] vs 1.1 [1.7]; 2.0, 1.1-3.6, p=0.02) and false-positive (2.3 [2.4] vs 0.9 [1.2]; 2.6, 1.3-5.0, p=0.005) cases. Referral patterns did not differ between low-intensity and PAU practices. Total cost per true-positive referral in the 2 year follow-up was £26,785 in high-intensity practices, £27,840 in low-intensity practices, and £30,007 in PAU practices. This intensive intervention to improve liaison between primary and secondary care for people with early signs of psychosis was clinically and cost effective. UK National Institute for Health Research.