A Cost Analysis of Childbirth for Pregnant Women with COVID-19 in Nigeria’s Epicentre

The Coronavirus disease 2019 (COVID-19) has been a major disruptor of health systems globally. Its emergence has warranted the need to reorganize maternity services for childbirth. However, it is not known if this comes at an additional cost to women. We conducted a hospital-based cost analysis to estimate the out-of-pocket cost of spontaneous vaginal delivery (SVD) and caesarean delivery (CD). Specifically, we collected facility-based and household costs of all nine pregnant women with COVID-19 who were managed between 1^st April and 30^th August 2020 at the largest teaching hospital in Lagos, the epicentre of COVID-19 in Nigeria. We compared the mean facility-based costs for the cohort with costs paid by pregnant women pre-COVID-19, identifying major cost drivers. We also estimated what would have been paid without subsidies, testing assumptions with a sensitivity analysis. Findings showed that total utilization cost ranged from US$494 (<strike>N</strike>190,150) for SVD with mild COVID-19 to US$4,553 (<strike>N</strike>1,751,165) for emergency CD with severe COVID-19. Though 32-66% of facility-based cost has been subsidized, cost of SVD and CD have doubled and tripled respectively during the pandemic compared to those paid pre-COVID. Out of the facility-based costs paid, cost of personal protective equipment (PPE) was the major cost driver (50%) for SVD and CD. Supplemental oxygen was a major cost driver when women had severe COVID-19 symptoms and required long admission (48%). Excluding treatment costs specifically for COVID-19, mean facility-based costs for SVD and CD are US$228 (<strike>N</strike>87,750) and US$948 (<strike>N</strike>364,551) respectively. Our study demonstrates that despite cost exemptions and donations, utilization costs remain prohibitive. Regulation of the PPE and medical oxygen supply chain can help drive down utilization cost and reduce mark-ups being passed to users. The pandemic offers an opportunity to expand advocacy for subscription to health insurance schemes in order to avoid any catastrophic health expenditure.