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An explorative cost-effectiveness analysis of intensive care and general ward admission for patients infected with COVID-19

Witte, Sytske de (2023) An explorative cost-effectiveness analysis of intensive care and general ward admission for patients infected with COVID-19.

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Abstract:Introduction: As a result of the COVID-19 pandemic, there high demand for intensive care (ICU) beds and a shortage of beds arose. The aim of this study is to investigate the cost-effectiveness of an ICU admission for treating COVID-19 versus general ward (GW) admission, together with a hypothetical situation where potential ICU patients did not go to the ICU (no-ICU). Methodology: The health economic evaluation performed was a cost-effectiveness analysis, in which a model was developed that consisted of a decision tree and a Markov model with a time horizon of one year from hospital admission. The two scenarios investigated were (1) ICU versus GW admission and (2) ICU versus no-ICU admission. In the analysis healthcare costs and health utility values during hospital admission and after discharge were included. Incremental costs and effects were then calculated. The Dutch cost-effectiveness threshold of € 80,000 was used to evaluate if ICU was cost-effective compared to GW and no-ICU based on the incremental cost-effectiveness ratio (ICER). Subgroup analysis based on gender, age (<65 years and ≥65 years), Body Mass Index (<25 and ≥25) and hypertension were performed. Results: In scenario one, ICU versus GW, the mean total costs were € 43,332 for ICU compared to € 3,947 for GW with total QALY’s of 0.393 for ICU compared to 0.501 for GW. It can be indicated that ICU is almost dominated by the GW. For scenario two, ICU versus no-ICU, the total costs of no-ICU were € 5,460 with a total of 0.066 QALY’s. The ICER for scenario two was € 115,850. The ICER is higher than the set WTP of € 80,000 therefore it can be indicated that ICU is not cost-effective compared to no-ICU. In the subgroup age <65 in scenario two the ICU may be considered cost-effective. Discussion & conclusion: It remains unclear which ward adds the most value in terms of costs and health benefits, due to unmeasured factors that could influence the outcome. More research will have to be done on comorbidities related to COVID-19 severity (such as diabetes, lung disease, cardiovascular disease, cancer and smoking) and delayed care due to the COVID-19 pandemic. Reason for this is to gain insight in patients who benefit most from ICU admission in terms of costs and health effects while also better describing a real-world scenario. With these results an ICU manager could make most efficient use of the ICU beds in a subsequent situation such as the COVID pandemic.
Item Type:Essay (Master)
Faculty:TNW: Science and Technology
Programme:Health Sciences MSc (66851)
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