Cost-effectiveness of intensive care for hospitalized Covid-19 patients: experience from South Africa (preprint)

ABSTRACT

BackgroundAmidst the shortages of critical care resources in the public sector resulting from the COVID-19 pandemic, the South African Government embarked on an initiative to purchase critical bed capacity from the private sector. Within an already under-funded public health sector, it is imperative that the costs and effects of potential interventions to care are assessed and weighed against the opportunity costs of their required investment. ObjectiveTo assess the cost-effectiveness of ICU management for admitted COVID-19 patients across the public and private health sector in South Africa. MethodsUsing a Markov modelling framework and a health system perspective, the costs and health outcomes of inpatient management of severe and critical COVID-19 patients in (1) general ward and intensive care (GW+ICU) and (2) general ward only were assessed. Disability adjusted life years (DALYs) were evaluated as health outcomes, and the cost per admission from public and private sectors was determined. The models made use of four variables mortality rates, utilisation of inpatient days for each management approach, disability weights associated to the severity of the disease, and the unit cost per general ward day and per ICU day in public and private hospitals. The unit costs were multiplied by utilisation estimates to determine the cost per admission. DALYs were calculated as the sum of years of life lost (YLL) and years lived with disability (YLD). An incremental cost-effectiveness ratio (ICER) representing the difference in costs and health outcomes of the two management strategies - was calculated and compared to a cost-effectiveness threshold to determine the value for money of ICU management. ResultsA cost per admission of ZAR 75,127 was estimated for inpatient management of severe and critical COVID-19 patients in general wards only as opposed to ZAR 103,030 in GW+ICU. DALYs were 1.48 and 1.10 in the general ward only and GW+ICU, respectively. The ratio of difference in costs and health outcomes between the two management strategies produced an ICER equal to ZAR 73 091 per DALY averted, a value above the cost-effectiveness threshold of ZAR 38 465. ConclusionsThis study indicated that purchasing additional ICU capacity from the private sector may not be a cost-effective use of limited health resources. The real time, rapid, pragmatic, and transparent nature of this analysis demonstrates a potential approach for further evidence generation for decision making relating to the COVID-19 pandemic response and South Africas wider priority setting agenda.