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IntroductionAlthough patients’ clinical conditions were previously shown to be associated with coronavirus disease 2019 (COVID-19) severity and outcomes, their impact on hospital costs is not known. The economic evaluation of COVID-19 admissions allows the assessment of hospital costs associated with the treatment of these patients, including the main cost components and costs driven by demographic and clinical conditions. The aim of this study was to determine the COVID-19 hospitalization-related costs and their association with clinical conditions.MethodsProspective observational cohort study of the hospitalization costs of patients with COVID-19 admitted between March 30 and June 30, 2020, who were followed until discharge, death, or external transfer, using micro-costing methodology. The study was carried out in the Central Institute of the Hospital das Clinicas, affiliated with the Faculty of Medicine of the University of Sao Paulo, Brazil, which is the largest hospital complex in Latin America and was designated to exclusively admit COVID-19 patients during the pandemic response.ResultsThe average cost of the 3,254 admissions (51.7% of which involved intensive care unit (ICU) stays) was US$12,637.42. Overhead cost was the main cost component, followed by daily fixed costs and drugs. Sex, age and underlying hypertension (US$14,746.77), diabetes (US$15,002.12), obesity (US$18,941.55), cancer (US$10,315.06), chronic renal failure (US$15,377.84), and rheumatic (US$17,764.61), hematologic (US$15,908.25) and neurologic diseases (US$15,257.95) were significantly associated with higher costs. Age >69 years, RT-PCR-confirmed COVID-19, comorbidities, the use of mechanical ventilation, dialysis, or surgery, and poor outcomes remained significantly associated with higher costs after model adjustment.ConclusionKnowledge of COVID-19-associated hospital costs and their impact across different populations can aid in the development of a generalizable and comprehensive approach to hospital preparedness, decision-making and planning for future risk management. Determining the disease-associated costs is the first step in evaluating the cost-effectiveness of treatments and vaccination programs.SUMMARY BOXQuestionWhat are the COVID-19 hospitalization-related costs?FindingsIn this prospective cohort that was carried out in a single reference quaternary center designated for the treatment of severe cases of COVID-19, more than three thousand patients were included, and their costs of hospitalization were found to be directly related to the age and comorbidities. The costs were more than 50% higher in older patients, 10-24% higher in patients with comorbidities, and 24-200% higher when additional therapeutic procedures were required.MeaningDetermining the disease-associated costs is the first step in conducting future evaluations of the cost-effectiveness of treatments and vaccination programs, supporting their implementation with a comprehensive population-based approach.

Chronic Non Communicable Diseases (NCD) are conditions that impact the quality of life of the population. The antioxidant vitamins - among them the vitamins A, C and E - are micronutrients that regulate the process of oxidative stress, present in the etiology of these diseases. Therefore, the objective of this quantitative and transversal study was to evaluate the factors associated with diabetes mellitus type 2, systemic arterial hypertension and obesity, especially those factors linked to the consumption of antioxidant vitamins in 112 women in preventive gynecological follow-up in an oncologic reference unit of the city of Francisco Beltrão, PR, Brazil. For the data collection, two questionnaires were applied to evaluate the nutritional and health status of the participants, anthropometric data, socioeconomic information, presence of comorbidities and consumption of food sources of antioxidant vitamins through the Questionnaire of Food Frequency (QFA). The results showed that 8.9% of the population who was studied had DM2, having as factors associated with minimum age of 50 years, presence of HAS and consumption of vitamin A. In the case of SAH, there was a prevalence of 32.1% and the only factor effectively associated was the presence of DM2. For obesity, no significant factor associated with it was observed. This study reinforces the evidence that the adequate intake of fruits and vegetables, for being sources of antioxidant nutrients, should be stimulated to prevent NCD. However, it is necessary to expand the studies on their relationship with these pathologies in a more generalist way. Las enfermedades crónicas no transmisibles (ENC) son condiciones que afectan a la calidad de vida de la población. Las vitaminas antioxidantes - entre ellas las vitaminas A, C y E - son micronutrientes que regulan el proceso de estrés oxidativo, presente en la etiología de estas enfermedades. Por lo tanto, el objetivo de este estudio cuantitativo y transversal fue evaluar los factores asociados con la diabetes mellitus tipo 2, la hipertensión arterial sistémica y la obesidad, especialmente aquellos factores vinculados con el consumo de vitaminas antioxidantes en 112 mujeres bajo seguimiento ginecológico preventivo en una unidad de referencia oncológica en la ciudad de Francisco Beltrão, PR, Brasil. Para la recolección de datos se aplicaron dos cuestionarios para evaluar el estado de nutrición y salud de los participantes, datos antropométricos, información socioeconómica, presencia de comorbilidades y consumo de fuentes alimentarias de vitaminas antioxidantes mediante el Cuestionario de Frecuencia de Alimentos (FA). Los resultados mostraron que el 8,9% de la población estudiada tenía DM2, teniendo como factores asociados a la edad mínima de 50 años, la presencia de HBP y el consumo de vitamina A. En el caso de la HSA, hubo una prevalencia del 32,1% y el único factor efectivamente asociado fue la presencia de DM2. En el caso de la obesidad, no se observó ningún factor significativo asociado a ella. Este estudio refuerza la evidencia de que el consumo adecuado de frutas y verduras, ya que son fuentes de nutrientes antioxidantes, debe ser estimulado para prevenir las enfermedades cardiovasculares. Sin embargo, es necesario ampliar los estudios sobre su relación con estas patologías de una manera más general. As Doenças Crônicas Não Transmissíveis (DCNT) são condições que impactam na qualidade de vida da população. As vitaminas antioxidantes - dentre elas as vitaminas A, C e E - são micronutrientes que regulam o processo de estresse oxidativo, presente na etiologia dessas doenças. Portanto, o objetivo deste estudo quantitativo e transversal foi de avaliar os fatores associados com diabetes mellitus tipo 2, hipertensão arterial sistêmica e obesidade, sobretudo aqueles fatores ligados com o consumo de vitaminas antioxidantes em 112 mulheres em acompanhamento ginecológico preventivo em unidade de referência oncológica da cidade de Francisco Beltrão, PR, Brasil. Para a coleta dos dados, foi efetuada a aplicação de dois questionários, visando avaliar o estado nutricional e de saúde das participantes, dados antropométricos, informações socioeconômicas, presença de comorbidades e o consumo de fontes alimentares das vitaminas antioxidantes por meio do Questionário de Frequência Alimentar (QFA). Os resultados mostraram que 8,9% da população estudada apresentou DM2, possuindo como fatores associados a idade mínima de 50 anos, presença de HAS e consumo de vitamina A. Em se tratando da HAS, verificou-se uma prevalência de 32,1% e o único fator efetivamente associado foi a presença de DM2. Já para a obesidade, não foi observado nenhum fator significativo associado a ela. O presente estudo reforça as evidências de que a ingestão adequada de frutas e hortaliças, por serem fontes de nutrientes antioxidantes, deve ser estimulada para prevenir as DCNT. No entanto, é necessário ampliar os estudos sobre a sua relação com essas patologias de forma mais generalista.

Background: Although patients’ clinical conditions were previously shown to be associated with coronavirus disease 2019 (COVID-19) severity and outcomes, their impact on hospital costs is not known. The economic evaluation of COVID-19 admissions allows the assessment of the direct and fixed hospital costs associated with the treatment of these patients, including the main cost components and costs driven by demographic and clinical conditions. Methods: This is a prospective observational cohort study of the hospitalization costs of patients with suspected and confirmed COVID-19 admitted between March 30 and June 30, 2020, to the largest referral hospital in Sao Paulo, Brazil, and followed until discharge, death, or external transfer. The cost investigation used a micro-costing methodology. Findings: The average cost of the 3,254 admissions (51.7% of which involved intensive care unit (ICU) stays) was US$12,637.42. Overhead cost was the main cost component, followed by daily fixed costs and drugs. Sex, age and underlying hypertension (US$14,746.77), diabetes (US$15,002.12), obesity (US$18,941.55), cancer (US$10,315.06), chronic renal failure (US$15,377.84), and rheumatic (US$17,764.61), hematologic (US$15,908.25) and neurologic diseases (US$15,257.95) were significantly associated with higher costs. Age >69 years, reverse-transcription polymerase chain reaction (RT-PCR)-confirmed COVID-19, comorbidities, the use of mechanical ventilation or dialysis, surgery and outcomes remained significantly associated with higher costs after model adjustment. Interpretation: Knowledge of COVID-19-associated hospital costs and their impact across different populations can aid in the development of a generalizable and comprehensive approach to hospital preparedness, decision-making and planning for future risk management. Determining the disease-associated costs is the first step in evaluating the cost-effectiveness of treatments and vaccination programs. Funding: This research was conducted without funding. Declaration of Interests: The authors have no conflicts of interest to declare. Ethics Approval Statement: The research protocol was approved by the institutional ethics committee (CAPPESQ: #4.107.580).

As Doenças Crônicas Não Transmissíveis (DCNT) são condições que impactam na qualidade de vida da população. As vitaminas antioxidantes - dentre elas as vitaminas A, C e E - são micronutrientes que regulam o processo de estresse oxidativo, presente na etiologia dessas doenças. Portanto, o objetivo deste estudo quantitativo e transversal foi de avaliar os fatores associados com diabetes mellitus tipo 2, hipertensão arterial sistêmica e obesidade, sobretudo aqueles fatores ligados com o consumo de vitaminas antioxidantes em 112 mulheres em acompanhamento ginecológico preventivo em unidade de referência oncológica da cidade de Francisco Beltrão, PR, Brasil. Para a coleta dos dados, foi efetuada a aplicação de dois questionários, visando avaliar o estado nutricional e de saúde das participantes, dados antropométricos, informações socioeconômicas, presença de comorbidades e o consumo de fontes alimentares das vitaminas antioxidantes por meio do Questionário de Frequência Alimentar (QFA). Os resultados mostraram que 8,9% da população estudada apresentou DM2, possuindo como fatores associados a idade mínima de 50 anos, presença de HAS e consumo de vitamina A. Em se tratando da HAS, verificou-se uma prevalência de 32,1% e o único fator efetivamente associado foi a presença de DM2. Já para a obesidade, não foi observado nenhum fator significativo associado a ela. O presente estudo reforça as evidências de que a ingestão adequada de frutas e hortaliças, por serem fontes de nutrientes antioxidantes, deve ser estimulada para prevenir as DCNT. No entanto, é necessário ampliar os estudos sobre a sua relação com essas patologias de forma mais generalista.