How much reserve capacity is justifiable for hospital pandemic preparedness? A cost-effectiveness analysis for COVID-19 in Germany

Gandjour, A.

Introduction: In preparation for a possible second COVID-19 pandemic wave, expanding intensive care unit (ICU) bed capacity is an important consideration. The purpose of this study was to determine the costs and benefits of this strategy 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 supplying one additional ICU bed is 24,815 euros per life year gained and increases with the number of additional beds. The NMB remains positive for utilization rates as low as 1.5% and, assuming full capacity utilization, for multiples of the currently available bed capacity. Expanding the ICU bed capacity by 10,000 beds is projected to result in societal costs of 41 billion euros and to reduce mortality of ICU candidates by 20% compared with no intervention (assuming full capacity utilization). In a sensitivity analysis, the variables with the highest impact on the MCER were the mortality rates in the ICU and after discharge. Conclusions: In Germany, the provision of additional ICU bed capacity appears to be cost-effective over a large increase in the number of beds. Nevertheless, bed utilization is constrained by labor supply and possibly other input factors.