Modelling the cost-effectiveness of essential and advanced critical care for COVID-19 patients in Kenya

Abstract

BackgroundCase management of symptomatic COVID-19 patients is a key health system intervention. The Kenyan government embarked to fill capacity gaps in essential and advanced critical care (ACC) needed for the management of severe and critical COVID-19. However, given scarce resources, gaps in both essential and ACC persist. This study assessed the cost-effectiveness of investments in essential and ACC to inform the prioritisation of investment decisions.MethodsWe employed a decision tree model to assess the incremental cost-effectiveness of investment in essential care (EC) and investment in both essential and ACC (EC +ACC) compared with current healthcare provision capacity (status quo) for COVID-19 patients in Kenya. We used a health system perspective, and an inpatient care episode time horizon. Cost data were obtained from primary empirical analysis while outcomes data were obtained from epidemiological model estimates. We used univariate and probabilistic sensitivity analysis to assess the robustness of the results.ResultsThe status quo option is more costly and less effective compared with investment in EC and is thus dominated by the later. The incremental cost-effectiveness ratio of investment in essential and ACC (EC+ACC) was US$1378.21 per disability-adjusted life-year averted and hence not a cost-effective strategy when compared with Kenya’s cost-effectiveness threshold (US$908).ConclusionWhen the criterion of cost-effectiveness is considered, and within the context of resource scarcity, Kenya will achieve better value for money if it prioritises investments in EC before investments in ACC. This information on cost-effectiveness will however need to be considered as part of a multicriteria decision-making framework that uses a range of criteria that reflect societal values of the Kenyan society.

Forecasting the spread of the COVID-19 pandemic in Kenya using SEIR and ARIMA models

“…This, therefore, implies that there is a need for preparedness; prioritization of supplemental oxygen support in general hospital wards to handle more of the severe cases. The findings of our study agree with those of Kairu et al ( Kairu et al, 2021 ); that the priority of investments should be on essential care for COVID-19 cases with severe infections. Our study is also comparable to that of Musa et al ( Musa et al, 2021 ) which recommended forecasting as an important tool to inform future epidemiological investigations and mitigation plans.…”

Cost-effectiveness of interventions for the prevention and control of COVID-19: Systematic review of 85 modelling studies

“…Of the remaining seven un-pooled studies about COVID-19 treatment, two concluded that COVID-19 vaccinations were cost-effective [ 11 , 102 - 105 ]. For lower-income economies like Kenya, investments in essential care before advanced critical care should be prioritised [ 106 ], and only one study reported general ward and intensive care was not cost-effective compared to general ward only [ 107 ].…”

“…Ferguson et al [ 108 ] suggested that suppression was the preferred policy option for countries that could achieve it, which is consistent with our results and explains the source of heterogeneity. With the rapid transmission speed of new variants and in contexts of weaker health systems, along with the greater vulnerability of developing economies to the negative impact of stringent measures, the trade-offs faced by low-income countries are complex [ 106 , 109 ]. In addition, low-income states lack the infrastructure for implementing technology-led containment strategies [ 110 ].…”

“…However, given scarce resources in lower-income economies, essential and advanced critical care needed for the management of severe and critical COVID-19 were both lacking. Kairu et al [ 106 ] found that Kenya could achieve better value-for-money if it prioritized investments in essential care before investments in advanced critical care.…”

Resource use, availability and cost in the provision of critical care in Tanzania: a systematic review

“…Given the lack of availability and access of critical care across Tanzania, such novel approaches may provide a building block to developing a fully resourced, equitable critical care system. 60 However, decision makers require further evidence on the optimal design, costs, budget impact and cost-effectiveness of such critical care interventions in rural and urban systems.…”