This study was led by KEMRI-WT with funding of iDSI. The aim was to cost the case management of COVID-19 patients from a health system perspective. The team used a microcosting approach, identifying all inputs required for clinical case management, their quantities and costs. They identified inputs and their quantities from the Kenya COVID-19 case management guidelines and obtained input costs from a study of 24 healthcare facilities in Kenya, 1 health facility providing COVID-19 case management services, and market prices for selected inputs.

Some of the key messages included:

• Per patient COVID-19 case management costs in hospitals are substantial ranging from KES 21,359 per day for asymptomatic patients, KES 21,361 per day for patients with mild symptoms, KES 24,705 for patients with severe disease and KES 51,684 for critical COVID-19 patients in ICU’s
• Per patient health system costs for COVID-19 case management are driven by PPE costs which accounts for approximately 65% of total costs
• Home based care for asymptomatic and mild COVID-19 patients is 9 times cheaper to the health system compared to institutional care (hospitals or isolation centers)
• The cost savings from home care should however be weighed against feasibility of home-based care and resultant impact on health outcomes (for COVID-19 patients, and transmission risk)
• If these costs are passed on to patients to pay out of pocket, they will result in significant catastrophe and impoverishment
• It is imperative therefore for the country to develop a prepayment mechanism to provide financial risk protection to patients and households against the financial hardship that they will face if required to pay for COVID-19 case management costs out of pocket

Read the full report here

In addition to this work, KEMRI worked on a cost-effectiveness of critical versus essential care for COVID patients (forthcoming); two rounds of epidemiological modelling for COVID-19 in the country (which were used to inform the decisions to implement Non-Pharmaceutical Interventions to reduce transmission) and possible future COVID vaccine HTA.

This work was led by KEMRI-WT as part of a multi-country project managed by the Center forGlobal Development and funded by the International Decision Support Initiative (iDSI). The study employed a mixed-methods approach, combining the analysis of secondary quantitative data obtained from the Kenya Health Information System database (from January 2019 to November 2020) and a qualitative inquiry involving key informant interviews and document reviews.

Some of the key findings included:

• We observed substantial reduction (24.67%) of inpatient utilization during the COVID-19 advent-month that may be attributed to COVID-19 and its mitigation measures.
• There was a substantial increase (0.15 cases [95%CI: 0.07 to 0.22]) in sexual violence cases per out-patient department visit after the start of COVID-19 and its implementation of mitigation measures in Kenya.
• COVID-19 did not affect the financing of essential health services and domestic supply chains. However, negative effects were reported on the international supply chain for health commodities, health infrastructure, service provision and patient access to healthcare services.
• The observed negative effects are thought to be transient leading to bounce back.
• Although our findings provide insights into the early effects of the COVID-19 pandemic and its mitigation measures in Kenya, there is a need for further in-depth analyses to fully explore both the direct and indirect effects of the pandemic as more and better-quality data become available.

Read the full paper here.