Unraveling COVID-19-Related Hospital Costs: The Impact of Clinical And Demographic Conditions

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).