Health-economic evaluation of the outpatient, inpatient, and public health sector in Germany: Insights from the first three COVID-19 waves.

AimThe aim of this study is to quantify the effectiveness and cost-effectiveness of the outpatient and inpatient sectors (specifically intensive care units, ICUs) and local health departments in managing the first three waves of the COVID-19 pandemic in Germany.MethodsThe analysis is based on a modelling approach using secondary data. The effectiveness of each sector was measured by determining the reduction in the case fatality rate (CFR) of COVID-19 patients by May 7, 2021. A counterfactual scenario assuming the absence of each sector was used to quantify their effectiveness. Direct medical costs for each sector were calculated from a statutory health insurance perspective, utilizing reimbursement rates for both the inpatient and outpatient sectors. Incremental cost-effectiveness ratios (ICERs) were determined, representing the costs per death avoided.ResultsThe ICUs achieved the greatest reduction in the CFR of COVID-19 patients during the first three waves (1.9%). The outpatient sector followed with a reduction of 1.4%, and the local health departments contributed to a 0.3% decrease in the CFR. In terms of spending, ICUs had the highest expenditures among the sectors, resulting in an ICER of €59,055 per death avoided. On the other hand, local health departments were costlier but less effective than the outpatient sector. Results remained consistent across various input assumptions.ConclusionDuring the first three waves of the COVID-19 pandemic in Germany, the inpatient sector (ICUs) made the largest contribution to preventing deaths while also incurring the highest costs.