A critical review of estimation of disease costs of COVID-19 pandemic in Low and Lower middle-income countries

Background COVID-19's emergence created a worldwide disaster, hitting nations of all income levels and causing catastrophic health and socioeconomic destruction. Due to differences in healthcare systems, demography, and containment measures, low and lower-middle-income nations (LMICs) had distinct problems in coping with the epidemic. Objectives This review synthesizes the existing evidence on the cost of treating COVID-19 in low and middle-income countries, including direct and indirect expenses and the methods employed in cost assessment. Methodology The review includes studies published after 2019, concentrating on COVID-19 patients in low and lower middle-income countries. Four studies complied to the inclusion criteria, demonstrating various methodological approaches, perspectives, cost components and regional variation across the healthcare system. Results Four studies from Iran, Kenya, Ghana and Ethiopia were included. Average direct medical costs per inpatient ranged from 321 to 3, 755, with ICU care consistently 2–4 times more expensive than general ward care. Key cost drivers included ICU services (up to 41%), staffing (up to 46%), medications (up to 35%), and PPE (up to 79%). Indirect costs, where reported, added substantially to the total burden. Conclusion COVID-19 imposed a significant economic burden in low- and lower-middle-income countries, with costs escalating sharply in severe and critical cases. ICU care, staffing, medications, and PPE are the primary cost drivers. These findings emphasized the need for cost-efficient strategies—such as early detection, home-based care, and targeted ICU use—to optimize resource allocation and reduce financial strain on health systems.