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

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 needed for the management of severe and critical COVID-19. However, given scarce resources, gaps in both essential and advanced critical care persist. This study assessed the cost-effectiveness of investments in essential and advanced critical care to inform the prioritization 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 advanced critical care (EC+ACC) compared to current health care 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 was obtained from primary empirical analysis while outcomes data was obtained from epidemiological model estimates. We used univariate and probabilistic sensitivity analysis (PSA) to assess the robustness of the results. ResultsThe status quo option is more costly and less effective compared to investment in essential care and is thus dominated by the later. The incremental cost effectiveness ratio (ICER) of Investment in essential and advanced critical care (EC+ACC) was US $1,378.21 per DALY averted and hence not a cost-effective strategy when compared to Kenyas cost-effectiveness threshold (USD 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 prioritizes investments in essential care before investments in advanced critical care. This information on cost-effectiveness will however need to be considered as part of a multi-criteria decision-making framework that uses a range of criteria that reflect societal values of the Kenyan society. Key questionsO_ST_ABSWhat is already known?C_ST_ABSO_LIThe COVID-19 pandemic is responsible for substantial health effects in low- and middle-income countries C_LIO_LIThe case management of COVID-19 is one of the key control interventions deployed by country health systems. C_LIO_LISimilar to other low- and middle-income countries, Kenya had substantial gaps in both essential and advanced critical care at the beginning of the pandemic. C_LI What are the new findings?O_LIProvision of essential care and advanced critical care for COVID-19 at the current health system capacity (status quo) was costly and the least effective strategy. C_LIO_LIInvestment in both essential care and advanced critical care for COVID-19 is not cost-effective in Kenya when compared to investment in essential care. C_LI What do the new findings imply?O_LIPrioritizing investments in filling capacity gaps in essential care before investing in filling capacity gaps in advanced critical care for COVID-19 is more cost-effective in Kenya C_LIO_LIThese findings are intended to inform the sequencing of investments in case management rather than the selection of either strategy, within a context of substantial resource constraint, and capacity gaps in both essential and advanced critical care or COVID-19 C_LIO_LIKenya will need to consider these findings on cost-effectiveness within a multi-criteria decision-making framework that use a range of criteria that reflect societal values. C_LI