Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
BMC Health Serv Res. 2021 Jan 22;21(1):82. doi: 10.1186/s12913-021-06081-4.
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.
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.
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.
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.
鉴于 COVID-19 大流行期间公立医院重症监护能力预计短缺，南非政府着手从私立医院购买该能力。为了为采购决策提供信息，我们评估了南非公共和私立卫生系统中 COVID-19 住院患者强化治疗管理的成本效益。
使用建模框架和卫生系统视角，评估了（1）普通病房和重症监护（GW+ICU）与（2）仅普通病房（GW）治疗严重和危重症 COVID-19 患者的住院管理成本和健康结果。评估了残疾调整生命年（DALY），并确定了公共和私营部门每次入院的费用。该模型利用了四个变量：死亡率、每种管理方法的住院天数利用、与疾病严重程度相关的残疾权重以及公立医院和私立医院普通病房和 ICU 每天的单位成本。单位成本乘以使用估计数以确定每次入院的费用。DALY 计算为生命损失年（YLL）和残疾生活年（YLD）的总和。增量成本效益比（ICER）-代表两种管理策略的成本和健康结果差异-与成本效益阈值进行比较，以确定 COVID-19 激增期间扩大 ICU 服务的性价比。
与 GW+ICU 相比，GW 中严重和危重新冠肺炎患者住院管理的每次入院费用估计为 ZAR75,127，而 GW+ICU 为 ZAR103,030。GW 的 DALY 为 1.48，GW+ICU 为 1.10。两种管理策略之间成本和健康结果差异的比率产生了每避免一个 DALY 的 ICER 为 ZAR73,091，高于成本效益阈值 ZAR38,465。
结果表明，在 COVID-19 激增期间从私立部门购买 ICU 能力可能不是一项具有成本效益的投资。这种“实时”、快速、务实和透明的分析方法展示了一种为与 COVID-19 大流行应对和南非更广泛的优先事项设置相关的决策生成证据的方法。
