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How Many Intensive Care Beds are Justifiable for Hospital Pandemic Preparedness? A Cost-effectiveness Analysis for COVID-19 in Germany
Applied Health Economics and Health Policy ( IF 3.6 ) Pub Date : 2021-01-12 , DOI: 10.1007/s40258-020-00632-2
Afschin Gandjour

Introduction

Germany is experiencing the second COVID-19 pandemic wave. The intensive care unit (ICU) bed capacity is an important consideration in the response to the pandemic. The purpose of this study was to determine the costs and benefits of maintaining or expanding a staffed ICU bed reserve capacity in Germany.

Methods

This study compared the provision of additional capacity to no intervention from a societal perspective. A decision model was developed using, e.g. information on age-specific fatality rates, ICU costs and outcomes, and the herd protection threshold. The net monetary benefit (NMB) was calculated based upon the willingness to pay for new medicines for the treatment of cancer, a condition with a similar disease burden in the near term.

Results

The marginal cost-effectiveness ratio (MCER) of the last bed added to the existing ICU capacity is €21,958 per life-year gained assuming full bed utilization. The NMB decreases with an additional expansion but remains positive for utilization rates as low as 2%. In a sensitivity analysis, the variables with the highest impact on the MCER were the mortality rates in the ICU and after discharge.

Conclusions

This article demonstrates the applicability of cost-effectiveness analysis to policies of hospital pandemic preparedness and response capacity strengthening. In Germany, the provision of a staffed ICU bed reserve capacity appears to be cost-effective even for a low probability of bed utilization.



中文翻译:

有多少张重症监护病床可为医院大流行做好准备?德国COVID-19的成本效益分析

介绍

德国正在经历第二次COVID-19大流行。重症监护病房(ICU)的床位是应对大流行病的重要考虑因素。这项研究的目的是确定在德国维持或扩大配备人员的ICU病床储备能力的成本和收益。

方法

这项研究从社会角度比较了在没有干预的情况下提供额外能力的情况。使用例如特定年龄死亡率,重症监护病房成本和结局以及牛群保护门槛等信息开发了决策模型。净货币收益(NMB)是根据支付治疗癌症的新药的意愿来计算的,该疾病在短期内具有相似的疾病负担。

结果

最后一张床的边际成本效益比(MCER)与现有ICU容量相加得出的假设使用全床的情况下,每生命年的边际成本效益比为21,958欧元。NMB随着进一步扩展而减少,但对于低至2%的利用率仍然保持正面。在敏感性分析中,对MCER影响最大的变量是ICU和出院后的死亡率。

结论

本文证明了成本效益分析在医院大流行防范和应对能力增强政策中的适用性。在德国,即使床使用率很低,提供配备人员的ICU床储备功能似乎也具有成本效益。

更新日期:2021-01-12
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