How Many Intensive Care Beds are Justifiable for Hospital Pandemic Preparedness? A Cost-effectiveness Analysis for COVID-19 in Germany

Gandjour, Afschin

doi:10.1007/s40258-020-00632-2

Cited by 34 publications

(42 citation statements)

References 19 publications

(18 reference statements)

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“… 10 Cleary et al 29 (South Africa) Hospitalized patients with COVID-19 General ward General ward + ICU Acute care, short-term decision tree to model health outcomes (recovered/deceased) of different hospital treatments ICER: cost/DALY averted (WTP:38 465.46/DALY averted) Cost-effectiveness Not reported Healthcare system perspective ICU use for patients with COVID-19 was unlikely to be cost-effective on the margin, and therefore an expansion of ICU capacity during COVID-19 surges through government purchase of private services for use by public sector patients (at current prices and evidence of effectiveness) may not be the best use of limited health resources. 12 Gandjour 31 (Germany) Hospitalized patients with COVID-19 Maintaining ICU bed capacity (do nothing) Expanding ICU bed capacity Life years gained computed using life-table model MCER of the last bed added to the existing ICU capacity (WTP: €101 493 per life-year gained); NMB; ROI Cost-effectiveness Lifetime Societal perspective Extending the existing ICU bed capacity seems acceptable on the basis of the MCER but also from a budgetary perspective. That is, extending capacity by more than 100% is forecast to result in a one-time increase in healthcare expenditure of 13%.…”

Section: Resultsmentioning

confidence: 99%

“…Of the 23 studies, 18 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 used a compartmental disease model to compute how SARS-CoV-2 spreads in the population. In contrast, 5 studies 24 , 28 , 29 , 30 , 31 , 32 combined different approaches such as decision trees and life-table models to model disease impacts. Of the 16 compartmental disease models, 13 used an extended version of the classical Susceptible-Exposed-Infectious-Recovered-Deceased model ( Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…Cleary et al 29 used a decision tree model to compute the short- and long-term effects of different treatment strategies in the hospital. Gandjour 31 used a life-table approach to compute the number of life-years lost to COVID-19.…”

Section: Resultsmentioning

confidence: 99%

“…Nine studies incorporated age stratification in their models, 10 , 11 , 15 , 17 , 18 , 20 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 12 studies incorporated presymptomatic infectiousness, 10–13 , 15–20 , 24 , 25 15 studies incorporated asymptomatic COVID-19 infections, 10–12 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 24 , 25 , 26 , 30 and 14 studies 10–15 , 17 , 18 , 20 , 22 , 24 , 25 , 28 , 29 incorporated differences in COVID-19 severity. Of the 16 compartmental disease models, 10 11 , 12 , 15–19 , 22 , 23 , 26 models assumed homogeneous mixing of the entire modeled population.…”

Section: Resultsmentioning

confidence: 99%

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Cost-Effectiveness of COVID-19 Policy Measures: A Systematic Review

et al. 2021

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Objectives The coronavirus disease 2019 pandemic has had a major impact on our society, with drastic policy restrictions being implemented to contain the spread of the severe acute respiratory syndrome coronavirus 2. This study aimed to provide an overview of the available evidence on the cost-effectiveness of various coronavirus disease 2019 policy measures. Methods A systematic literature search was conducted in PubMed, Embase, and Web of Science. Health economic evaluations considering both costs and outcomes were included. Their quality was comprehensively assessed using the Consensus Health Economic Criteria checklist. Next, the quality of the epidemiological models was evaluated. Results A total of 3688 articles were identified (March 2021), of which 23 were included. The studies were heterogeneous with regard to methodological quality, contextual factors, strategies’ content, adopted perspective, applied models, and outcomes used. Overall, testing/screening, social distancing, personal protective equipment, quarantine/isolation, and hygienic measures were found to be cost-effective. Furthermore, the most optimal choice and combination of strategies depended on the reproduction number and context. With a rising reproduction number, extending the testing strategy and early implementation of combined multiple restriction measures are most efficient. Conclusions The quality assessment highlighted numerous flaws and limitations in the study approaches; hence, their results should be interpreted with caution because the specific context (country, target group, etc) is a key driver for cost-effectiveness. Finally, including a societal perspective in future evaluations is key because this pandemic has an indirect impact on the onset and treatment of other conditions and on our global economy.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Cost-Effectiveness of COVID-19 Policy Measures: A Systematic Review

et al. 2021

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“…First, the costs of care related to COVID-19 patients can be substantial for hospitals because of long hospital stays, isolation treatment, and complex care on ICUs. Significant investments have been made in many countries to expand ICU and hospital capacity and workforce [6] . In addition, stricter hygiene standards, physical distancing requirements, greater use of PPEs, and widespread testing, have made it costlier and time consuming to treat non-COVID patients.…”

Section: Introductionmentioning

confidence: 99%

Balancing financial incentives during COVID-19: A comparison of provider payment adjustments across 20 countries

et al. 2022

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Provider payment mechanisms were adjusted in many countries in response to the COVID-19 pandemic in 2020. Our objective was to review adjustments for hospitals and healthcare professionals across 20 countries. We developed an analytical framework distinguishing between payment adjustments compensating income loss and those covering extra costs related to COVID-19. Information was extracted from the Covid-19 Health System Response Monitor (HSRM) and classified according to the framework. We found that income loss was not a problem in countries where professionals were paid by salary or capitation and hospitals received global budgets. In countries where payment was based on activity, income loss was compensated through budgets and higher fees. New FFS payments were introduced to incentivize remote services. Payments for COVID-19 related costs included new fees for out- and inpatient services but also new PD and DRG tariffs for hospitals. Budgets covered the costs of adjusting wards, creating new (ICU) beds, and hiring staff. We conclude that public payers assumed most of the COVID-19-related financial risk. In view of future pandemics policymakers should work to increase resilience of payment systems by: (1) having systems in place to rapidly adjust payment systems; (2) being aware of the economic incentives created by these adjustments such as cost-containment or increasing the number of patients or services, that can result in unintended consequences such as risk selection or overprovision of care; and (3) periodically evaluating the effects of payment adjustments on access and quality of care.

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The economics of the COVID-19 pandemic: economic evaluation of government mitigation and suppression policies, health system innovations, and models of care

Antioch

2023

J Public Health (Berl.)

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Background The COVID-19 pandemic has impacted the scope of health economics literature, which will increasingly examine value beyond health care interventions such as government policy and broad health system innovations. Aim The study analyzes economic evaluations and methodologies evaluating government policies suppressing or mitigating transmission and reducing COVID-19, broad health system innovations, and models of care. This can facilitate future economic evaluations and assist government and public health policy decisions during pandemics. Methods The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was used. Methodological quality was quantified using the scoring criteria in European Journal of Health Economics, Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 Checklist and the National Institute for Health and Care Excellence’s (NICE) Cost Benefit Analysis Checklist. PUBMED, Medline, and Google Scholar were searched from 2020–2021. Results Cost utility analysis (CUA) and cost benefit analysis (CBA) analyzing mortality, morbidity, quality adjusted life year (QALY) gained, national income loss, and value of production effectively evaluate government policies suppressing or mitigating COVID-19 transmission, disease, and impacting national income loss. The WHO’s pandemic economic framework facilitates economic evaluations of social and movement restrictions. Social return on investment (SROI) links benefits to health and broader social improvements. Multi-criteria decision analysis (MCDA) can facilitate vaccine prioritization, equitable health access, and technology evaluation. Social welfare function (SWF) can account for social inequalities and population-wide policy impact. It is a generalization of CBA, and operationally, it is equal to an equity-weighted CBA. It can provide governments with a guideline for achieving the optimal distribution of income, which is vital during pandemics. Economic evaluations of broad health system innovations and care models addressing COVID-19 effectively use cost effectiveness analysis (CEA) that utilize decision trees and Monte Carlo models, and CUAs that effectively utilize decision trees and Markov models, respectively. Conclusion These methodologies are very instructive for governments, in addition to their current use of CBA and the value of a statistical life analytical tool. CUA and CBA effectively evaluate government policies suppressing or mitigating COVID-19 transmission, disease, and impacts on national income loss. CEA and CUA effectively evaluate broad health system innovations and care models addressing COVID-19. The WHO’s framework, SROI, MCDA, and SWF can also facilitate government decision-making during pandemics. Supplementary Information The online version contains supplementary material available at 10.1007/s1...

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How Many Intensive Care Beds are Justifiable for Hospital Pandemic Preparedness? A Cost-effectiveness Analysis for COVID-19 in Germany

Cited by 34 publications

References 19 publications

Cost-Effectiveness of COVID-19 Policy Measures: A Systematic Review

Cost-Effectiveness of COVID-19 Policy Measures: A Systematic Review

Balancing financial incentives during COVID-19: A comparison of provider payment adjustments across 20 countries

The economics of the COVID-19 pandemic: economic evaluation of government mitigation and suppression policies, health system innovations, and models of care

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