Since the recent outbreak of the Coronavirus, we have seen public health officials declare that many developing nations do not have the financial capabilities to manage the healthcare treatment options for individuals who become infected with this virus.
This has prompted the question, what are the potential costs of the available healthcare options for COVID-19 positive patients?
No known cure
At this stage, there is NO KNOWN cure for this virus with 100% certainty, however, research for vaccinations and cure continues fervently. In the interim, official guidance from public health authorities is to proceed with caution when adopting any of the speculative treatment options
Current healthcare approaches
Across the developed world, the preferred treatment approach has been to TEST individuals who display symptoms of the COVID-19 virus, after which patients are broadly categorized into 4 groups with a variety of healthcare approaches as outlined in the table below
From a public health perspective, there is arguably a two-fold gap with the current approach.
- Firstly, individuals who test positive but have low health effects are currently permitted to return to their house but with self-quarantine recommended. This is simply an honor-based system which relies on these set of individuals doing the honorable thing.
- Secondly, asymptomatic individuals (i.e. individuals who do not display COVID-19 symptoms) are NOT typically tested, leaving them free to roam and potentially expose other individuals.
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The number of individuals who are either not tested or being asked to self-quarantine is not known but is estimated to be in hundreds of millions of people globally.
As an example, in the United States, only 1.7million people have been tested as at 6th April 2020, in a country of over 300 million individuals. There is simply no way 300 million people will ever be tested in the USA. Therefore, given existing financial resource constraints, it will be impossible to cater to the health of these groups of individuals.
Unit cost per COVID-19 patient
In the United States of America, a number of health spending reports were released in March 2020 from Kaiser Health Foundation, as well as, FAIR Health, Inc.
These reports estimated the cost range of treating a single COVID-19 patient requiring hospitalization to be within $5,000 to $88,000 per person depending on severity and duration of hospital stay
Nigerian perspective
Nigeria’s health authorities are yet to publish an official COVID-19 cost estimate per person. However, for simplicity, let’s assume a conversion factor of 0.15 (in other words, the cost of treatment in Nigeria will be 15% of treatment costs in the United States.
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This may be too low if you believe the World Bank’s Price level ratio PPP Conversion factor of 0.339 or33.9%. But for now, let’s argue that cheaper labour costs savings in Nigeria will exceed the cost of importing medical equipment, COVID test kits, and reagents, etc.
This 15% estimate will mean an average cash outlay of $750 to $13,000 (or N270,000 to N4.7million per person depending on the duration of hospital stay i.e. 6 days stay or 23day intensive care hospitalization). This multiplied by a forecast of 39,000 positive cases in Lagos means a potential cash outlay of N10.5 billion just for Lagos alone. This, of course, excludes economic impact, never mind the residual 35 states in Nigeria
Interestingly, ExpatAssure (a health insurance broker for expatriates) estimates an average healthcare cost of $275 for a single night in a Nigerian hospital with an additional $110 average cost for consultation (i.e. likely cash outlay for 6 days is $1,650 or N594,000). Understandably, people will argue vigorously that decades of mismanagement of / underinvestment in the healthcare sector is now coming back to haunt Nigeria and Africa.
However, whichever estimate is chosen, the absolute cash outlay for treating COVID-19 patients will not be trivial. More worryingly it remains to be seen how these costs will be funded and repaid by FG and States.
Thank you for the analysis. So far different countries have used different strategies to combat COVID 19. Nigeria needs to choose a coat effective option that suits our epedmiologic and fiscal needs. In my opinion, I think the only applicable costs are those for Category E. Category D do not need to be tested and certainly don’t require admission. They can stay at home and simple analgesics and rest. Most will recover. This is also the strategy employed in the UK. There should be no testing and thus no costs associated with Categories A, B and C (especially when we are outside the containment phase) . We can model the population transmission and prevalence based on hospital admissions i.e. cases. This will also help reduce the cost of intervention and help our health workers focus on those who really require them.
The other way to estimate the cost is to estimate that 5% of positive cases will require hospital admission. This is about the range seen elsewhere and may even be lower with us given we have a significantly younger population. For Lagos, I’d double the 39,000 estimated as we are likely under testing and to offer a safe allowance in planning. This will mean about 80,000 cases in the next few weeks if things go well. Of these 5% will require testing and admission – 4000 cases. I think the cost will be substantially less.
Comment:Above all said and done,we dont value ourselves and the government is passive about our situation