ABSTRACT
Objectives: Efficiency analyses of health systems are often limited to hospital applications or macroeconomic evaluations considering a single production process. This application using a two-stage prevention and cure network perspective highlights nonparametric frontier estimations more coherently with the current COVID-19 pandemic scenario. Methods: This two-stage Data Envelopment Analysis methodology estimates cost efficiencies of preventing an increasing propagation of COVID-19 using the Federal Government COVID-19 expenditures as input and the inverse rate of cases as output (standardized by population) in the first stage. The second stage for the technical efficiency (cure model) has the number of ICUs, ventilators and medical staff (nurses, assistants and physicians) as input and success rate (the difference between the number of infected and deaths) as output. Results: Two efficient states on both prevention and cure models (Acre and Roraima). Pernambuco is deemed efficient in preventing COVID-19 (3 states total), and São Paulo, Mato Grosso, Amapá, Santa Catarina and Rio Grande do Sul (7 states) in cure. About 1400 ICU admissions, 590 ventilators and more than 100 thousand medical staff can be spared directed by best practices from these seven efficient states. The most inefficient states in preventing the pandemic are São Paulo (0.028), Bahia (0.076), Rio Grande do Sul (0.087) and Paraná (0.098), also reporting low social isolation. The most inefficient states in cure are Rio de Janeiro (0.231), Pernambuco (0.277), and Rio Grande do Norte (0.439). Conclusions: The proposed methodology offers an interesting framework combining both public health perspectives as responses to the COVID-19 pandemic. Brief comments can be made on Pernambuco's mapping technologies available for the general population;the cooperation between the government and NGOs in Roraima for providing EPIs, tests, food and hygiene items for indigenous districts (reducing potential propagations without expanding governments expenditures);and Acre's campaigns for basic hygiene, and pandemic control.