COVID-19-related hospital cost-outcome analysis: The impact of clinical and demographic factors

Abstract

Introduction Although patients’ clinical conditions have been shown to be associated with coronavirus disease (COVID-19) severity and outcome, their impact on hospital costs are not known. This economic evaluation of COVID-19 admissions aimed to assess direct and fixed hospital costs and describe their particularities in different clinical and demographic conditions and outcomes in the largest public hospital in Latin America, located in São Paulo, Brazil, where a whole institute was exclusively dedicated to COVID-19 patients in response to the pandemic. Methods This is a partial economic evaluation performed from the hospital´s perspective and is a prospective, observational cohort study to assess hospitalization costs of suspected and confirmed COVID-19 patients admitted between March 30 and June 30, 2020, to Hospital das Clínicas of the University of São Paulo Medical School (HCFMUSP) and followed until discharge, death, or external transfer. Micro- and macro-costing methodologies were used to describe and analyze the total cost associated with each patient's underlying medical conditions, itinerary and outcomes as well as the cost components of different hospital sectors. Results The average cost of the 3,254 admissions (51.7% of which involved intensive care unit stays) was US$12,637.42. The overhead cost was its main component. Sex, age and underlying hypertension (US$14,746.77), diabetes (US$15,002.12), obesity (US$18,941.55), chronic renal failure (US$15,377.84), and rheumatic (US$17,764.61), hematologic (US$15,908.25) and neurologic (US$15,257.95) diseases were associated with higher costs. Age strata >69 years, reverse transcription polymerase chain reaction (RT-PCR)-confirmed COVID-19, comorbidities, use of mechanical ventilation or dialysis, surgery and outcomes remained associated with higher costs. Conclusion Knowledge of COVID-19 hospital costs can aid in the development of a comprehensive approach for decision-making and planning for future risk management.

Economic burden and catastrophic health expenditure associated with COVID-19 hospitalisations in Kerala, South India

“…The 75 th round of National Sample Survey (NSS) carried out in the year 2017 reports the average medical expenditure incurred during Hospitalisation was more than seven fold in a private hospital than in a government hospital (MOSPI, 2019). The analysis from the present study adds to a group of studies that have established that comorbid conditions are significantly associated with increasing medical costs for hospitalisations for COVID-19 (Carrera-Hueso et al, 2021;Chua et al, 2021;Miethke-Morais et al, 2021). Even though the existing body of evidence from low and middle income countries emphasizes on the role of health insurance in protecting households from catastrophic health costs,the present study did not identify such an association in the regression model (Huffman et al, 2011).…”

Financial Burden and Catastrophic Health Expenditure Associated with COVID-19 Hospitalizations in Kerala, South India

“…36 The analysis from the present study adds to a group of studies that have established that comorbid conditions are significantly associated with increasing medical costs for hospitalizations for COVID-19. 23,24,37 Even though the existing body of evidence from low and middle income countries emphasizes the role of health insurance in protecting households from catastrophic health costs, the present study did not identify such an association in the regression model. 38 Recent research has demonstrated that coverage under the public health insurance programs for those below poverty line had no significant influence on decreasing OOP expenditure payments.…”

Which patients bring the most costs for hospital? A study on the cost determinants among COVID-19 patients in Iran

“…Ohsfeldt et al in the US found that by increasing in the patient age, hospitalization cost decreased that is in line to the present finding [ 15 ]. Another study in the Brazil showed that hospitalization costs decreased by increasing in age, too [ 16 ].…”

“…However, the results of a systematic review showed that being a man was related to the severe COVID-19 [ 13 ], in our study, gender did not change the median cost in both hospitalization periods. Other studies in the US and the Brazil showed that men had a higher cost compared to women [ 15 , 16 ]. However, they did not divide patients based on the length of stay.…”