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• The indirect costs of COVID-19 patients were higher compared to direct costs. • The highest mean hospitalization cost of the disease was observed in hoteling. • The highest mean outpatient cost of the disease was observed in medicine. • The highest proportion of indirect cost was related to missed workdays. This study aimed to estimate the cost of COVID-19 patients and some affecting factors in Iran. This was a prevalence-based cost-of-illness study based on a bottom-up costing approach which was conducted from March 2020 to July 2020. Data were extracted from the hospital's Hospital Information System (HIS) and Cost-of-illness (COI) assessment checklist. Indirect costs were assessed based on the Human Capital Approach. Data were analyzed using SPSS software version 22 and Microsoft EXCEL 2016. A total of 745 Covid-19 patients were included in the analysis. The mean total cost was estimated at 8813.15 (PPP, Current International $), accounting for 60% of GDP per capita. The mean direct and indirect cost was 3362.49 (PPP, Current International $) (38% of the total cost and 23% of the GDP per capita), and 5450.66 (PPP, Current International $) (62% of the total cost and 37% of the GDP per capita), respectively. The mean hospitalization cost was higher among patients who died and those who were covered by supplemental insurance. Also, the costs of disease experienced a dramatic rise with increasing age. For different scenarios in terms of outbreak rate, hospitalization rate and mortality rate, the total estimated cost of illness for Covid-19 ranged from 6263 million (PPP, Current International $) to 63,474 million (PPP, Current International $). Covid-19 imposes a substantial financial burden on people, health care systems, insurance organizations and the country's economy as a whole. Since the economic burden of this disease increases dramatically by increasing disease outbreak, more attention should be paid to the development and implementation of appropriate preventive programs. [ABSTRACT FROM AUTHOR]