Examining unit costs for COVID-19 case management in Kenya

  1. Edwine Barasa
  2. Angela Kairu
  3. Wangari Ng'ang'a
  4. Marybeth Maritim
  5. Vincent Were
  6. Samuel Akech
  7. Mercy Mwangangi

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Abstract

We estimated unit costs for COVID-19 case management for patients with asymptomatic, mild-to-moderate, severe and critical COVID-19 disease in Kenya.

Methods

We estimated per-day unit costs of COVID-19 case management for patients. We used a bottom-up approach to estimate full economic costs and adopted a health system perspective and patient episode of care as our time horizon. We obtained data on inputs and their quantities from data provided by three public COVID-19 treatment hospitals in Kenya and augmented this with guidelines. We obtained input prices from a recent costing survey of 20 hospitals in Kenya and from market prices for Kenya.

Results

Per-day, per-patient unit costs for asymptomatic patients and patients with mild-to-moderate COVID-19 disease under home-based care are 1993.01 Kenyan shilling (KES) (US$18.89) and 1995.17 KES (US$18.991), respectively. When these patients are managed in an isolation centre or hospital, the same unit costs for asymptomatic patients and patients with mild-to-moderate disease are 6717.74 KES (US$63.68) and 6719.90 KES (US$63.70), respectively. Per-day unit costs for patients with severe COVID-19 disease managed in general hospital wards and those with critical COVID-19 disease admitted in intensive care units are 13 137.07 KES (US$124.53) and 63 243.11 KES (US$599.51).

Conclusion

COVID-19 case management costs are substantial, ranging between two and four times the average claims value reported by Kenya’s public health insurer. Kenya will need to mobilise substantial resources and explore service delivery adaptations that will reduce unit costs.

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  1. Version published to 10.1136/bmjgh-2020-004159
  2. ScreenIT

    SciScore for 10.1101/2020.10.08.20209684: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This analysis has several limitations. First, we extensively relied on normative guidelines assumptions and cost data from previous studies, and only collected data from 3 COVID-19 treatment centers because it was impossible to carry out real world extensive data collection given existing physical distancing restrictions. However, this limitation is mitigated by the fact that there is no specific COVID-19 treatment and that COVID-19 case management reflects management of non-COVID-19 patients with the same symptoms. The cost survey we relied on was also relatively recent. Second, this analysis presents data for public sector costs. Private sector costs would be useful given that the COVID-19 response will require governments to purchase services from both the public and private sector in settings like Kenya where the private sector plays a significant role in healthcare service provision. Third, input costs for some items, especially PPE’s are volatile because of market disruptions and are likely to stabilize much later, and thus reducing the unit costs of case management. We have however used market prices 8 months into the pandemic which are likely to be closer to the stable prices in the future rather than the costs at the beginning of the pandemic. Third, we did not analyse costs for the range of possible COVID-19 complications. This is because unit costs exist for some of these, for instance for kidney replacement therapy, and costing the entire range of possible complic...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.10.08.20209684v1 on medRxiv