Cost-Effectiveness Analysis of Implementing a Field Hospital during a Pandemic

OBJECTIVES: The study aimed to assess the impact of the Pacaembu Field Hospital in São Paulo, Brazil, throughout the COVID-19 pandemic, specifically focusing on lives saved and the associated public health costs.

METHODS: Conducted between April 6th and June 29th, 2020, this retrospective cohort study included COVID-19 patients. The field hospital, a collaboration between Sociedade Beneficente Israelita Brasileira Albert Einstein and the São Paulo City Hall, operated at Pacaembu Stadium with 200 beds, admitting adult patients with mild to moderate COVID-19 without signs of severity. Electronic health records provided comprehensive data on demographics, clinical outcomes, and resource utilization. The mortality rates among field hospital patients were evaluated in comparison to two scenarios: 1) confirmed COVID-19 cases in São Paulo, and 2) severe acute respiratory syndrome patients with COVID-19 in São Paulo.

RESULTS: Among the 1,499 patients (53.84% males, median age 57), 14.20% utilized the stabilization room, and 7.94% required mechanical ventilation. The hospital contributed to saving 61 and 44 lives for men and women, respectively, translating to 1,252 and 872 years of life saved. Adjusting for mortality rates using IBGE’s complete life table, the hospital potentially saved 158 lives, representing 3,332 years of life. After age and sex adjustments, 102 and 83 lives saved equated to 2,193 and 1,784 years of life saved for men and women, respectively. The cost-effectiveness analysis revealed in Scenario 1 a cost per incremental life saved ranging from R$210,462.90 (US$39,046.92) to R$250,198.83 (US$46,419.08) for men and women, respectively. In Scenario 2, the cost per incremental life saved was higher, varying from R$442,697.83 (US$82,133.18) to R$29,418.51 (US$5,457.98) for men and women.

CONCLUSIONS: the study underscores the Pacaembu Field Hospital's substantial contribution to saving lives during the initial COVID-19 wave, emphasizing the need for continuous evaluation and resource optimization in field hospital strategies for an effective pandemic response.