Utilization cost of maternity services for childbirth among pregnant women with COVID-19 in Nigeria's epicenter.

OBJECTIVE: To estimate utilization cost of spontaneous vaginal delivery (SVD) and caesarean delivery (CD) for pregnant women with Coronavirus Disease (COVID-19) at the largest teaching hospital in Lagos, the pandemic's epicenter in Nigeria.

METHODS: We collected facility-based and household costs of all nine pregnant women with COVID-19 managed at the hospital. We compared their mean facility-based costs with those paid by pregnant women pre-COVID-19, identifying cost-drivers. We also estimated what would have been paid without subsidies, testing assumptions with a sensitivity analysis.

RESULTS: Total utilization cost ranged from US$494 for SVD with mild COVID-19 to US$4,553 for emergency CD with severe COVID-19. Though 32-66% of facility-based cost were subsidized, cost of SVD and CD during the pandemic have doubled and tripled respectively compared to those paid pre-COVID. Of the facility-based costs, cost of personal protective equipment (PPE) was the major cost-driver (50%). Oxygen was the major driver for women with severe COVID-19 (48%). Excluding treatment costs for COVID-19, mean facility-based costs were US$228 (SVD) and US$948 (CD).

CONCLUSION: Despite cost exemptions and donations, utilization costs remain prohibitive. Regulation of PPE and medical oxygen supply chains and expansion of advocacy for health insurance enrolments are needed to minimize catastrophic health expenditure.