Determination of COVID-19 intensive care costs in Germany and assessment of the economic impact on the healthcare system - a nationwide retrospective cohort study from January 2020 to March 2022

Background In late 2021, the German statutory health insurance (SHI) funds reported average expenditures for the treatment of coronavirus disease 2019 (COVID-19) intensive care patients without mechanical ventilation at €8,000 and even more than €30,000 for those with mechanical ventilation. In this context, there is currently no further information on the total COVID-19 intensive care costs or an assessment of the economic impact on the German health care system. Methods A retrospective cohort study was conducted from January 01, 2020, to March 31, 2022, using nationwide inpatient billing data and the proportion of mechanically ventilated COVID-19 intensive care patients in Germany. The COVID-19 intensive care costs were then determined based on reported cost accounting estimates for nonventilated and ventilated intensive care unit (ICU) bed days. The health economic impact was assessed by relating the COVID-19 intensive care costs to SHI expenditures and the cost of illness for the German hospital sector. Results By the end of March 2022, German hospitals had spent a total of 2.2 million ICU bed days, including 1.2 million (55%) ventilated ICU bed days, for COVID-19 intensive care patients. Up to this point, the corresponding treatment costs were almost €3.0 billion. The annual COVID-19 intensive care costs more than doubled from €776 million in 2020 to €1.7 billion in 2021. This meant a cost increase of €203.1 million to €486 million for nonventilated ICU bed days and €573.2 million to €1.2 billion for ventilated ICU bed days. The cost share of COVID-19 intensive care in SHI expenditures for hospital treatment was predominantly less than 2.0%, and approximately 6.0% of the cost of illness for the hospital sector in 2020. Conclusions In conclusion, COVID-19 intensive care has become a rapidly growing cost factor for the German healthcare system, with the frequent use of mechanical ventilation being an important cost driver. However, compared to the SHI expenditures and cost of illness for the hospital sector, the cost share of COVID-19 intensive care appeared rather low. A more valid assessment of the health economic impact of COVID-19 intensive care in Germany requires case-specific billing data and consideration of costs associated with the displaced treatment of non-COVID-19 patients.