Stark choices: Exploring health sector costs of policy responses to COVID-19 in low-income and middle-income countries

Sergio Torres-Rueda, Sedona Sweeney, Fiammetta Bozzani, Nichola R. Naylor, Tim Baker, Carl Pearson, Rosalind Eggo, Simon R. Procter, Nicholas Davies, Matthew Quaife, Nichola Kitson, Marcus R. Keogh-Brown, Henning Tarp Jensen, Nuru Saadi, Mishal Khan, Maryam Huda, Angela Kairu, Raza Zaidi, Edwine Barasa, Mark JitAnna Vassall

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)


Objectives: COVID-19 has altered health sector capacity in low-income and middle-income countries (LMICs). Cost data to inform evidence-based priority setting are urgently needed. Consequently, in this paper, we calculate the full economic health sector costs of COVID-19 clinical management in 79 LMICs under different epidemiological scenarios. Methods: We used country-specific epidemiological projections from a dynamic transmission model to determine number of cases, hospitalisations and deaths over 1 year under four mitigation scenarios. We defined the health sector response for three base LMICs through guidelines and expert opinion. We calculated costs through local resource use and price data and extrapolated costs across 79 LMICs. Lastly, we compared cost estimates against gross domestic product (GDP) and total annual health expenditure in 76 LMICs. Results: COVID-19 clinical management costs vary greatly by country, ranging between <0.1%-12% of GDP and 0.4%-223% of total annual health expenditure (excluding out-of-pocket payments). Without mitigation policies, COVID-19 clinical management costs per capita range from US$43.39 to US$75.57; in 22 of 76 LMICs, these costs would surpass total annual health expenditure. In a scenario of stringent social distancing, costs per capita fall to US$1.10-US$1.32. Conclusions: We present the first dataset of COVID-19 clinical management costs across LMICs. These costs can be used to inform decision-making on priority setting. Our results show that COVID-19 clinical management costs in LMICs are substantial, even in scenarios of moderate social distancing. Low-income countries are particularly vulnerable and some will struggle to cope with almost any epidemiological scenario. The choices facing LMICs are likely to remain stark and emergency financial support will be needed.

Original languageEnglish
Article numbere005759
JournalBMJ Global Health
Issue number12
Publication statusPublished - 2 Dec 2021


  • COVID-19
  • health economics


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