Treating Covid-19 costly affair for the poor, says research

Kenyans have spent billions of shillings on treatment of Covid-19 since March 13 when the first case of the pandemic was reported in Nairobi, a new study has revealed. 

A research report uploaded by Kenyan scientists on the online health sciences portal, Journal MedRxiv, estimates that it costs about Sh24,000 to treat an asymptomatic Covid-19 patient under home-based isolation and care, with the cost surging to more than Sh712,000 for patients who become critically ill from the viral infection and require hospital admission.

The report by a team of Kenya Medical Research Institute (Kemri) researchers who included the Chief Administrative Secretary at the Ministry of Health, Dr Mercy Mwangangi, Edwine Barasa, Angela Kairu, Wangari Nganga, Marybeth Maritim, Vincent Were and Samuel Akech paints a gloomy picture of a deadly pandemic that is ravaging Kenyans’ health as well as their wealth.

“Covid-19 case management costs are substantial. Kenya will not only need to mobilise substantial resources to finance Covid-19 case management but also explore additional service delivery adaptations that will reduce unit costs,” say the researchers in their findings.

Personal protective equipment (PPE) for doctors and patients is the single-most expensive item for treating Covid-19 followed by payments to medical personnel and the cost of medicines, according to a breakdown published in the report.

A full PPE kit goes for about Sh10,000, and is used for a single session per patient, and due to the special care required a doctor could visit the patient several times a day.

Hospital admission, laboratory tests, oxygen therapy and equipment cost; including ventilators and monitoring in the ICU, make up the other costs for patients who become severely to critically ill.

Huge costs

The report averaged patient costs in both public health facilities. The cost of Covid-19 admission in a private hospital ICU could hit as much as Sh120,000 per day, making it out of reach for an overwhelming majority of Kenyans.

For those who catch the virus but remain asymptomatic, and under home based care, it costs at least Sh24,000 in the two weeks you will be under isolation, mostly in protective gear and nutrition.

Some 90 per cent of Kenyan coronavirus cases are asymptomatic, according to the Health ministry, setting a conservative estimate of treating the disease for the more than 55,000 who have so far contracted the virus at more than Sh1.2 billion.

Most Kenyans are forced to hold fundraisers or sell property to pay for their treatment, in cases where the government and insurance companies decline to foot the bills.

“Kenya will need mechanisms to protect Covid-19 patients from the financial burden of healthcare costs to access Covid-19 services,” states the report.

“If these costs are passed on to patients as direct healthcare costs, they will result in substantial levels of catastrophic healthcare expenditures and impoverishment. There is an urgent need for Kenya 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 ... out of pocket.”

For asymptomatic patients who do not have home facilities that can accommodate their isolation and require to be admitted in an isolation centre or hospital, it costs up to Sh7,417 per day to manage them, totalling Sh88,983 for two weeks; the same bill as those with mild to moderate symptoms of the disease.

Mild symptoms

According to the report, patients with mild to moderate symptoms only incur additional costs for symptom relievers such as paracetamol, while the use of Personal Protective Equipment (PPEs) accounts for the largest share of costs at Sh18,856 per patient.

These categories of patients hardly receive any medicines, do not undergo any radiological tests, and do not receive supplemental oxygen.

The cost of home care is also lower because these patients avoid hospitalisation and overhead costs and require minimal medic-patient physical interactions and hence saves on staffing, accommodation, and PPE costs, say the researchers.

The unit costs for patients with severe Covid-19 disease and admitted to general hospital wards is Sh12,570 per day or Sh150,849 while those with critical Covid-19 disease admitted in Intensive Care Units pay Sh59,369 per day or Sh712,433 , the research states.

“Patients with critical disease incur higher intensive care related costs that include specialist staff (e.g. critical care physicians, anaesthetists) and more staff time per patient, pharmaceuticals (antibiotics and anaesthesia medicine) and non-pharmaceuticals (e.g. total parenteral nutrition), mechanical ventilation, other monitoring equipment costs,” say the researchers.

“The bill varies, depending on the virus load, related ailments, age and other factors,” Acting Director of Health Dr Patrick Dr Amoth had told the Nation in a past interview, adding that most of the cost goes to the protective gear used by medical staff.

Sustainable financing

According to the cost analysis, pharmaceuticals and PPEs are the key contributors to costs for the management of patients with severe Covid-19 at Sh71,946 and Sh243,176, respectively.

“This is because more health workers are involved in the care of these patients (increasing PPE costs) and the patients receive pharmaceutical and non-pharmaceutical interventions such as antibiotics, fluids and oxygen,” the researchers say.

Staff costs (up to Sh350,500) contribute the largest share of costs for critical Covid-19 patients because they need more medical staff and staff time as well as more specialised care (such as physicians and anaesthetists) which cost more, the report says.

The report shows that there is an urgent need to develop a sustainable financing arrangement for Covid-19 given that if these costs were to be borne by patients, then it will push them into penury.

“The findings show that Covid-19 case management costs are substantial for all treatment categories and increase as severity increases. These high costs have several implications, including putting a fiscal strain on the healthcare system because of existing resource challenges. Kenya will need to actively mobilise both domestic and donor resources to meet these costs,” the researchers say.

[email protected]