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How Many Intensive Care Beds are Justifiable for Hospital Pandemic Preparedness? A Cost-effectiveness Analysis for COVID-19 in Germany


  • Afschin Gandjour

    (Frankfurt School of Finance and Management)


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.

Suggested Citation

  • Afschin Gandjour, 2021. "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, Springer, vol. 19(2), pages 181-190, March.
  • Handle: RePEc:spr:aphecp:v:19:y:2021:i:2:d:10.1007_s40258-020-00632-2
    DOI: 10.1007/s40258-020-00632-2

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    References listed on IDEAS

    1. Afschin Gandjour, 2006. "Consumption costs and earnings during added years of life ‐ a reply to Nyman," Health Economics, John Wiley & Sons, Ltd., vol. 15(3), pages 315-317, March.
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    Blog mentions

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    1. Journal round-up: Applied Health Economics and Health Policy 19(2)
      by karanshahk2 in The Academic Health Economists' Blog on 2021-04-19 06:00:07


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    Cited by:

    1. Bernard Michael Gilroy & Marie Wegener & Christian Peitz, 2021. "COVID-19 and Triage - A Public Health Economic Analysis of a Scarcity Problem," Working Papers CIE 147, Paderborn University, CIE Center for International Economics.
    2. Waitzberg, Ruth & Gerkens, Sophie & Dimova, Antoniya & Bryndová, Lucie & Vrangbæk, Karsten & Jervelund, Signe Smith & Birk, Hans Okkels & Rajan, Selina & Habicht, Triin & Tynkkynen, Liina-Kaisa & Kesk, 2022. "Balancing financial incentives during COVID-19: A comparison of provider payment adjustments across 20 countries," Health Policy, Elsevier, vol. 126(5), pages 398-407.
    3. Frank Daumann & Florian Follert & Werner Gleißner & Endre Kamarás & Chantal Naumann, 2021. "Political Decision Making in the COVID-19 Pandemic: The Case of Germany from the Perspective of Risk Management," IJERPH, MDPI, vol. 19(1), pages 1-23, December.
    4. Florian Follert & Werner Gleißner & Dominik Möst, 2021. "What Can Politics Learn from Management Decisions? A Case Study of Germany’s Exit from Nuclear Energy after Fukushima," Energies, MDPI, vol. 14(13), pages 1-15, June.

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