Cost of intensive care services at a central hospital in South Africa

Mahomed, Saajida; Mahomed, Ozayr

doi:10.7196/samj.2018.v109i1.13268

Cited by 22 publications

(18 citation statements)

References 15 publications

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“… 35 In another study, Mahomed & Mahomed estimated daily ICU costs in South Africa for other conditions. 36 Although their estimates were higher than ours, Mahomed & Mahomed found that human resource costs was the highest cost driver of total ICUs costs, similar to our findings. 36 There are a few limitations of our study worth highlighting.…”

Section: Discussionsupporting

confidence: 89%

Inpatient Care Costs of COVID-19 in South Africa’s Public Healthcare System

Edoka

Fraser

Jamieson

et al. 2021

Int J Health Policy Manag

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Background: Coronavirus disease 2019 (COVID-19) has had a devastating impact globally, with severe health and economic consequences. To prepare health systems to deal with the pandemic, epidemiological and cost projection models are required to inform budgets and efficient allocation of resources. This study estimates daily inpatient care costs of COVID-19 in South Africa, an important input into cost projection and economic evaluation models. Methods: We adopted a micro-costing approach, which involved the identification, measurement and valuation of resources used in the clinical management of COVID-19. We considered only direct medical costs for an episode of hospitalisation from the South African public health system perspective. Resource quantities and unit costs were obtained from various sources. Inpatient costs per patient day was estimated for consumables, capital equipment and human resources for three levels of inpatient care – general wards, high care wards and intensive care units (ICUs). Results: Average daily costs per patient increased with the level of care. The highest average daily cost was estimated for ICU admissions – 271 USD to 306 USD (financial costs) and ~800 USD to 830 USD (economic costs, excluding facility fee) depending on the need for invasive vs. non-invasive ventilation (NIV). Conversely, the lowest cost was estimated for general ward-based care – 62 USD to 79 USD (financial costs) and 119 USD to 278 USD (economic costs, excluding facility fees) depending on the need for supplemental oxygen. In high care wards, total cost was estimated at 156 USD, financial costs and 277 USD, economic costs (excluding facility fees). Probabilistic sensitivity analyses suggest our costs estimates are robust to uncertainty in cost inputs. Conclusion: Our estimates of inpatient costs are useful for informing budgeting and planning processes and cost-effectiveness analysis in the South African context. However, these estimates can be adapted to inform policy decisions in other context.

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Section: Discussionsupporting

confidence: 89%

Inpatient Care Costs of COVID-19 in South Africa’s Public Healthcare System

Edoka

Fraser

Jamieson

et al. 2021

Int J Health Policy Manag

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Section: Introductionmentioning

confidence: 99%

Cost‐effectiveness of intensive care for hospitalized COVID-19 patients: experience from South Africa

Cleary

Wilkinson

Tamandjou

et al. 2021

BMC Health Serv Res

102

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Background Given projected shortages of critical care capacity in public hospitals during the COVID-19 pandemic, the South African government embarked on an initiative to purchase this capacity from private hospitals. In order to inform purchasing decisions, we assessed the cost-effectiveness of intensive care management for admitted COVID-19 patients across the public and private health systems in South Africa. Methods Using a modelling framework and health system perspective, costs and health outcomes of inpatient management of severe and critical COVID-19 patients in (1) general ward and intensive care (GW + ICU) versus (2) general ward only (GW) were assessed. Disability adjusted life years (DALYs) were evaluated and the cost per admission in public and private sectors was determined. The model made use of four variables: mortality rates, utilisation of inpatient days for each management approach, disability weights associated with severity of disease, and the unit cost per general ward day and per ICU day in public and private hospitals. 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 difference in costs and health outcomes of the two management strategies - was compared to a cost-effectiveness threshold to determine the value for money of expansion in ICU services during COVID-19 surges. Results A cost per admission of ZAR 75,127 was estimated for inpatient management of severe and critical COVID-19 patients in GW as opposed to ZAR 103,030 in GW + ICU. DALYs were 1.48 and 1.10 in GW versus GW + ICU, respectively. The ratio of difference in costs and health outcomes between the two management strategies produced an ICER of ZAR 73,091 per DALY averted, a value above the cost-effectiveness threshold of ZAR 38,465. Conclusions Results indicated that purchasing ICU capacity from the private sector during COVID-19 surges may not be a cost-effective investment. The ‘real time’, rapid, pragmatic, and transparent nature of this analysis demonstrates an approach for evidence generation for decision making relating to the COVID-19 pandemic response and South Africa’s wider priority setting agenda.

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“…Intensive care services are very expensive and are one of the largest drivers of hospital costs, even in public hospitals where the cost per patient per ICU day has been estimated at R22,700. [2] Discovery Health, the largest medical scheme in the country, at the time reported that the average cost of all COVID-19 hospital admissions across its members was R84,708. The average cost of an ICU admission for its members was substantially higher - at R169,525 and these admissions were also reported to have the “highest variation in cost”.…”

Section: Background and Aim Of Studymentioning

confidence: 99%

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

Cleary

Wilkinson

Tchuem

et al. 2020

Preprint

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Background: Amidst 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. Objective: To assess the cost-effectiveness of ICU management for admitted COVID-19 patients across the public and private health sector in South Africa. Methods: Using 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. Results: A 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. Conclusions: This 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 the wider priority setting agenda in South Africa.

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Cost of intensive care services at a central hospital in South Africa

Abstract: This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Cited by 22 publications

References 15 publications

Inpatient Care Costs of COVID-19 in South Africa’s Public Healthcare System

Inpatient Care Costs of COVID-19 in South Africa’s Public Healthcare System

Cost‐effectiveness of intensive care for hospitalized COVID-19 patients: experience from South Africa

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

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