Operational Costs and Revenue Dynamics of Repurposing a Public Hospital into a COVID-19 Isolation Centre in Kenya: A...

Isolation facilities are essential to pandemic response, yet the economic trade-offs of repurposing existing hospitals remain poorly characterised. This study quantifies both the operational costs and the revenue foregone from converting Tigoni Level 4 Hospital (TL4H) into Kiambu County's sole COVID-19 isolation centre. Our study focused on estimating recurrent and labour costs, considering only capital costs incurred during the study period. We conducted a cost analysis at the facility level, assessing all expenditures incurred by TL4H between June 2020 and February 2022, using an activity-based costing approach to allocate costs to specific operational activities. Sensitivity analyses, including one-way and 10,000-draw Monte Carlo PSA, estimated uncertainty in total and per-patient costs. The total operational cost of the isolation centre over the 21 months was KES 489,220,113.98 (USD 4,181,011.14). This translates to an annual operating cost of KES 279,554,350.85 (USD 2,389,149.23). The average cost of managing one COVID-19 patient regardless of severity was estimated as KES 337,626.03 (USD 2885.45). The revenue foregone by waiving user fees for COVID-19 patients was KES 160,678,901.00 (USD 1,374,236). Sensitivity analysis indicated that HRH costs (78.9% of total expenditure) had the largest influence: a ±20% change shifted total costs by ±KES 77.6 million (USD 663,191.18). PSA results showed a mean total operational cost of KES 489,212,852 (USD 4,180,949.08; 95% UI: 414,803,680-573,687,849), and a mean cost per patient of KES 337,621.02 (USD 2885.40; 95% UI: 286,268.93-395,919.84). Repurposing TL4H as a COVID-19 isolation centre was resource-intensive, highlighting the importance of strategic budget planning and resource allocation for future preparedness.