The COVID-19 pandemic has caused profound health, economic, and social disruptions globally. We assessed the full costs of hospitalization for COVID-19 disease at Ekka Kotebe COVID-19 treatment center in Addis Ababa, the largest hospital dedicated to COVID-19 patient care in Ethiopia. Methods and findings: We retrospectively collected and analyzed clinical and cost data on patients admitted to Ekka Kotebe with laboratory-confirmed COVID-19 infections. Cost data included personnel time and salaries, drugs, medical supplies and equipment, facility utilities, and capital costs. Facility medical records were reviewed to assess the average duration of stay by disease severity (either moderate, severe, or critical). The data collected covered the time-period March-November 2020. We then estimated the cost per treated COVID-19 episode, stratified by disease severity, from the perspective of the provider. Over the study period, there were 2,543 COVID-19 cases treated at Ekka Kotebe, of which, 235 were critical, 515 were severe, and 1,841 were moderate. The mean patient duration of stay varied from 9.2 days (95% CI: 7.6-10.9; for moderate cases) to 19.2 days (17.9-20.6; for critical cases). The mean cost per treated episode was USD 1,473 (95% CI: 1,197-1,750), but cost varied by disease severity: the mean cost for moderate, severe, and critical cases were USD 1,266 (998-1,534), USD 1,545 (1,413-1,677), and USD 2,637 (1,788-3,486), respectively. Conclusions: Clinical management and treatment of COVID-19 patients pose an enormous economic burden to the Ethiopian health system. Such estimates of COVID-19 treatment costs inform financial implications for resource-constrained health systems and reinforce the urgency of implementing effective infection prevention and control policies, including the rapid rollout of COVID-19 vaccines, in low-income countries like Ethiopia.

• Hospitalization costs
• COVID-19
• Addis Ababa
• treatment center
• Ekka Kotebe
• ICU
• Empirical data

Not mentioned by the data generating unit.

In order to control COVID-19, the Ethiopian government established quarantine, isolation, and COVID-19 testing and treatment facilities in Addis Ababa, the capital city, and in all regional states. Furthermore, case management, infection prevention, and control protocols were developed and distributed to designated isolation and treatment centers, along with health workforce capacity-building measures. Ekka Kotebe treatment center, the largest dedicated COVID-19 treatment center in Ethiopia, was the first facility established for clinical management of Real-Time Polymerase Chain Reaction (RT-PCR) confirmed COVID-19 cases in Ethiopia.

The clinical management of patients infected with COVID-19 varies depending on disease severity and pre-existing comorbidities. Patients with critical illness may require mechanical ventilation and admission to intensive care units (ICU), which not only carry substantial costs but has limited availability, as there is a critical shortage of ICU facilities in low-and middle-income countries like Ethiopia. The “second wave” of the pandemic is currently underway in most African countries, including Ethiopia, which could severely overwhelm national health systems.

Ethiopia has the second largest population in Africa, with an estimated 112 million inhabitants in 2019. It is a low-income country with a gross domestic product per capita of around USD 900 (2019) and severe financial and infrastructure constraints. Prior to the pandemic, the Ethiopian government spent only USD 33 per capita on health, and there are only 77 physicians per million population (one of the lowest physician densities in the world). As such, even before the COVID-19 pandemic, Ethiopia was facing critical challenges in health service delivery and financing. Therefore, understanding and quantifying the direct economic impact of treating COVID-19 patients is essential for guiding health policy decision-making and resource mobilization in Ethiopia and beyond in other sub-Saharan African countries. However, studies on the cost of care for COVID-19 patients are scarce in low- and middle-income countries and in sub-Saharan Africa in particular. In this paper, we aim to estimate the treatment costs associated with inpatient hospital admissions of COVID-19 patients in Ethiopia’s largest dedicated treatment center.

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