The costing of COVID-19 intensive care units at a tertiary hospital in Cape Town, South Africa

Hood, Kirsten

The costing of COVID-19 intensive care units at a tertiary hospital in Cape Town, South Africa

Thesis / Dissertation

2024

Abstract

Background: The expansion of Groote Schuur Hospital's (GSH) Intensive Care Unit (ICU) capacity to accommodate an unprecedented number of patients during the COVID-19 pandemic was an expensive undertaking. There are currently no published formal retrospective analyses of the financial costs of running and expanding COVID-ICUs in South Africa. Objectives: To conduct a cost analysis of the COVID-ICU service at a tertiary state hospital in Cape Town, South Africa. This analysis included the cost of COVID-ICU admissions relating to the first four COVID waves. Aims were to estimate total costs, in-patient day costs, and cost drivers for COVID-ICU. Methods: A retrospective cost analysis (quantitative observational study) using a mixed methods costing approach, was conducted across the COVID-ICUs at GSH. The data used included two consecutive hospital financial years, between April 2020 and March 2022. Costs were calculated monthly and then combined to achieve a total cost over the two-year period. COVID-ICU in-patient days were used as the primary allocation factor. Cost inputs included recurrent costs such as human resources, diagnostics, pharmaceuticals, oxygen, enteral feeds, blood products, consumables, and overheads, as well as capital costs including equipment, and building space. Results: The study period covered the four COVID waves that affected GSH ICU units between April 2020 and March 2022. This period included 10 497 COVID-ICU in-patient days resulting from a total of 776 COVID-ICU admissions. The total calculated spending across the two financial years was R262 482 904, resulting in a cost per in-patient day of R25 006, and a utilisation of 4,4% of the total hospital budget during the same period. The median length of stay was nine days, resulting in a median cost per admission of R225 050. The top five cost drivers were human resources (60%), consumables (9%), pharmaceuticals (8%), oxygen (5%), and overheads (5%). Conclusion: This is a retrospective costing study of the COVID-ICUs at a tertiary hospital in Cape Town, throughout the entire portion of the pandemic that required ICU admissions in South Africa. This analysis provides useful financial insights, a potential economic model for ICU budgeting, and creates a platform for future economic analyses and policy planning regarding level-of-care decisions for general ICU admissions or for similar future pandemics within the South African and LMIC hospital setting.