Direct Medical Cost Analysis of Indian COVID-19 Patients Requiring Critical Care Admission

Abstract

A bstract Introduction Intensive care unit (ICU) admission is required for approximately 25% of patients affected with coronavirus disease-19 (COVID-19) and imposes a high economic burden on patients in resource-limited settings. Method We conducted a retrospective direct medical care cost analysis of COVID-19 patients requiring ICU admission after obtaining the Institutional Ethics Committee approval. Data were obtained from the records of patients admitted to the COVID-19 ICU of a tertiary care trust teaching hospital from June 2020 to December 2020. Direct costs were analyzed and correlated with various demographic variables and clinical outcomes. Results A total of 176 patients were included (males—76%). The median direct medical cost for a median stay of 13 days was INR 202248.5 ($ 2742.91). Hospital drugs and disposables accounted for 20% of the total cost followed by bed charges (19%), equipment charges (17%), biosafety protective gear (15.5%), pathological and radiological tests (15%), clinical management (7.6%), and biomedical waste management (1.6%). Government schemes accounted for 79% of medical claims followed by directly paying patients (12.5%) and private insurance (8.5%). The cost was significantly higher in patients with diabetes mellitus and sepsis and in those requiring mechanical ventilation (MV) ( p <0.05). Shorter lead time to hospital admission and lesser length of hospital stay were associated with significant lower direct cost. Conclusion Direct medical care cost is substantial for COVID-19 patients requiring ICU admission. This cost is significantly associated with increased ICU and hospital stay, longer lead time to admission, diabetes mellitus, sepsis, and those who need high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), and MV. How to cite this article Reddy KN, Shah J, Iyer S, Chowdhury M, Yerrapalem N, Pasalkar N, et al . Direct Medical Cost Analysis of Indian COVID-19 Patients Requiring Critical Care Admission. Indian J Crit Care Med 2021;25(10):1120–1125.

Costs of inpatient care and out-of-pocket payments for COVID-19 patients: A systematic review

“…and reported [10,[26][27][28]. In studies where the total cost was reported for all patients, the cost per person was calculated using the number of people who used the service [29].…”

Economic costs related to coronavirus disease 2019 pandemic: A systematic literature review

“…Summing up, most of the studies considered here (nine articles) only focus on the analysis of direct costs and take into consideration economic costs related to hospitalization, RT-PCR for SARS-CoV-2, ICU stay, or chest radiograph, among others. Only four articles examine other types of costs or several types of costs at the same time, such as indirect costs, including those associated with the cost of missed workdays (patients as well as 19 Tsai et al 20 ), Asia (Khan et al; 21 Lee et al; 22 Li et al; 23 Reddy et al; 24 Ebrahimipour et al; 25 Darab et al; 26 Jin et al; 27 Nakhaei et al 28 ), and Europe (Romeyke and Stummer 16 ; Carrera-Hueso et al; 29 Maltezou et al 30 ). Note 2-Countries by area: America (United States), Asia (Saudi Arabi, Korea, China, Iran, and India), and Europe (Spain, Greece, and Germany).…”

“…It should be noted that around 70% of the sample (exactly, 69.23% of them) only focused on direct costs. Besides, regarding country information, it is obtained for America (United States), Asia (Saudi Arabi, Korea, China, Iran, and India) and Europe (Spain, Greece, and Germany) being their corresponding references for each area the following: America (Di Fusco et al; 19 Tsai et al 20 ), Asia (Khan et al; 21 Lee et al; 22 Li et al; 23 Reddy et al; 24 Ebrahimipour et al; 25 Darab et al; 26 Jin et al; 27 Nakhaei et al 28 ), and Europe (Romeyke and Stummer 16 ; Carrera-Hueso et al; 29 Maltezou et al 30 ).…”

“…Meanwhile, Li et al 23 carry out a cost and affordability analysis to determine the medical costs of COVID-19 patients. Reddy et al 24 conducted a cost analysis of COVID-19 patients requiring ICU admission. Similarly, Ebrahimipour et al 25 evaluate both diagnostic and therapeutic costs of hospitalized patients with a diagnosis or suspected of COVID-19 disease.…”

Semiotics of ICU Physicians’ Views on End-of-life Care and Quality of Dying in a Critical Care Setting: A Qualitative Study

“… 49 Moreover, catastrophic health expenses due to severe illness leading to impoverishment or bankruptcy have been reported in India, the US, and China. 50 , 51 Decisions regarding withholding and withdrawing therapy are often challenging, and the study suggests that withholding therapy or non-escalation of therapy is more accessible than withdrawing therapy, especially the ventilator. Withdrawal of therapy is less common in the Indian (and Asian) setting as compared to the West.…”