Hospitalization costs of patients with Covid-19: A study in Tehran University of Medical Sciences

Document Type : Original Article

Authors

1 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran; Iran.

2 Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background: The present study was carried out to analyze the costs involved with COVID-19 in one of the largest hospitals in Iran.
Methods: In this descriptive study, the total costs of hospitalization in Imam Khomeini Hospital affiliated to Tehran University of Medical Sciences for COVID-19 confirmed patients were analyzed until April 17, 2020. Data were extracted by reviewing patient record bills, and analyzed using descriptive and analytical statistics in SPSS 21.
Results: Data related to 1324 patients with COVID-19 were analyzed. Totally, 32.4% of all hospitalized patients had comorbidities, and 13.7% required intensive care and were admitted to the ICU. The average cost per hospitalized patient was 33,121,029 Rials (US $ 209.22), but this average had a high standard deviation (66,936,158 Rials, US $ 422.82). There was a significant difference in costs based on the length of stay (P-value = 0.000), ICU hospitalization (P-value = 0.000), presence of comorbidities (P-value = 0.002), age (P-value = 0.002) and gender (P-value = 0.002), but the results of path analysis showed that only the variables of length of stay and hospitalization in the ICU had a direct effect on the costs and other factors had indirect effects.
Conclusions: COVID-19 is imposing significant costs on the health system, a significant proportion of which belongs to the length of hospital stay and the need to intensive care units. Directing resources to expand timely diagnostic capacity and manage disease in the early stages can both reduce the financial burden of providing highly costly inpatient services.
 

Keywords


1. Institute for Health Metrics and Evaluation (IMHE) [Internet]. Global Burden of Disease 2017. [Cited 12 January 2021]. Available from: https://vizhub.healthdata.org/gbd-compare/
2. World Health Organization [Internet]. Coronavirus disease 2019 (COVID-19) Situation Report – 86 2020. [Cited 26 June 2021]. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200415-sitrep-86-covid-19.pdf?sfvrsn=c615ea20_6
3. World Health Organization [Internet]. Naming the coronavirus disease (COVID-19) and the virus that causes it. [Cited 2 October 2020]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it
4. Arabi YM, Murthy S, Webb S. COVID-19: a novel coronavirus and a novel challenge for critical care. Intensive Care Med. 2020;46(5):833-6. doi: 10.1007/s00134-020-05955-1.
5. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun. 2020;109:102433. doi: 10.1016/j.jaut.2020.102433.
6. Petrosillo N, Viceconte G, Ergonul O, Ippolito G, Petersen E. COVID-19, SARS and MERS: are they closely related? Clin Microbiol Infect. 2020;26(6):729-34. doi: 10.1016/j.cmi.2020.03.026.
7. Gates B. Responding to Covid-19 - A Oncein-a-Century Pandemic? N Engl J Med. 2020;382(18):1677-9. doi: 10.1056/NEJMp2003762.
8. United Nations [Internet]. Shared responsibility, global solidarity: Responding to the socioeconomic impacts of COVID-19 2020. [Cited 12 April 2021]. Available from: https://unsdg.un.org/sites/default/files/2020-03/SG-Report-Socio-Economic-Impact-of-Covid19.pdf
9. World Health Organization [Internet]. Coronavirus disease (COVID-19) Weekly Epidemiological Update and Weekly Operational Update 2020. [Cited 11 February 2021]. Available from: https://www.who.int/emergencies/diseases/novelcoronavirus2019/situation-reports/
10. Lee J-W, McKibbin WJ. Estimating the global economic costs of SARS. Learning from SARS: preparing for the next disease outbreak: workshop summary. Nationa l Academies Press, Washington, DC. 2004:92.
11. AlRuthia Y, Somily AM, Alkhamali AS, Bahari OH, AlJuhani RJ, Alsenaidy M, et al. Estimation Of Direct Medical Costs Of Middle East Respiratory Syndrome Coronavirus Infection: A Single-Center Retrospective Chart Review Study. Infect Drug Resist. 2019;12:3463-73. doi: 10.2147/IDR.S231087
12. World Bank [Internet]. COVID-19 (coronavirus) and the future of health financing: from resilience to sustainability 2020. [Cited 28 March 2021]. Available from: https://blogs.worldbank.org/health/covid-19-coronavirus-and-future-healthfinancing-resilience-sustainability
13. Maliszewska M, Mattoo A, Van Der Mensbrugghe D. The potential impact of COVID-19 on GDP and trade: A preliminary assessment. World Bank Policy Research Working Paper. 2020(9211). doi: 10.1596/1813-9450-9211.
14. International Monetary Fund (IMF) [Internet]. World Economic Outlook, April 2020 2020. [Cited 30 December 2020]. Available from: https://www.imf.org/en/Publications/WEO/Issues/2020/04/14/weo-april-2020
15. Li R, Rivers C, Tan Q, Murray MB, Toner E, Lipsitch M. Estimated Demand for US Hospital Inpatient and Intensive Care Unit Beds for Patients With COVID-19 Based on Comparisons With Wuhan and Guangzhou, China. JAMA Netw Open. 2020;3(5):e208297. doi: 10.1001/jamanetworkopen.2020.8297.
16. Canadian Institute for Health Information [Internet]. Estimated costs for COVID-19 hospital stays 2020. [Cited 03 April 2021]. Available from: https://www.cihi.ca/en/covid-19-hospital-stayscost-3-times-more-than-a-stay-for-heart-attack
17. Jeck J, Jakobs F, Kron A, Franz J, Cornely OA, Kron F. A cost of illness study of COVID-19 patients and retrospective modelling of potential cost savings when administering remdesivir during the pandemic “first wave” in a German tertiary care hospital. Infection. 2021. doi: 10.1007/s15010-021-01685-8.
18. Raoofi A, Takian A, Akbari Sari A, Olyaeemanesh A, Haghighi H, Aarabi M. COVID-19 Pandemic and Comparative Health Policy Learning in Iran. Arch Iran Med. 2020;23(4):220-34. doi: 10.34172/aim.2020.02.
19. Kokabisaghi F. Assessment of the Effects of Economic Sanctions on Iranians’ Right to Health by Using Human Rights Impact Assessment Tool: A Systematic Review. Int J Health Policy Manag. 2018;7(5):374-93. doi: 10.15171/ijhpm.2017.147.
20. Noy I, Doan N, Ferrarini B, Park D. Measuring the Economic Risk of COVID‐19. Global Policy. 2020;11(4):413-23. doi: 10.1111/1758-5899.12851.
21. Takian A, Raoofi A, Kazempour-Ardebili S. COVID-19 battle during the toughest sanctions against Iran. Lancet. 2020;395(10229):1035-6. doi: 10.1016/S0140-6736(20)30668-1.
22. Bartsch SM, Ferguson MC, McKinnell JA, O’Shea KJ, Wedlock PT, Siegmund SS, et al. The Potential Health Care Costs And Resource Use Associated With COVID-19 In The United States. Health Aff (Millwood). 2020;39(6):927-35. doi: 10.1377/hlthaff.2020.00426.
23. Central Bank of the Islamic Republic of Iran [Internet]. Monthly economic indicators and statistics 2020. [Cited 20 August 2021]. Available from: https://www.cbi.ir/simplelist/20216.aspx
24. Ghaffari Darab M, Keshavarz K, Sadeghi E, Shahmohamadi J, Kavosi Z. The economic burden of coronavirus disease 2019 (COVID-19): evidence from Iran. BMC Health Serv Res.2021;21(1):132. doi: 10.1186/s12913-021-06126-8.
25. Moses MW, Pedroza P, Baral R, Bloom S, Brown J, Chapin A, et al. Funding and services needed to achieve universal health coverage: applications of global, regional, and national estimates of utilisation of outpatient visits and inpatient admissions from 1990 to 2016, and unit costs from 1995 to 2016. Lancet Public Health. 2019;4(1):e49-e73. doi: 10.1016/S2468-2667(18)30213-5.
26. Khan AA, AlRuthia Y, Balkhi B, Alghadeer SM, Temsah MH, Althunayyan SM, et al. Survival and Estimation of Direct Medical Costs of Hospitalized COVID-19 Patients in the Kingdom of Saudi Arabia. Int J Environ Res Public Health. 2020;17(20). doi: 10.3390/ijerph17207458.
27. Li XZ, Jin F, Zhang JG, Deng YF, Shu W, Qin JM, et al. Treatment of coronavirus disease 2019 in Shandong, China: a cost and affordability analysis. Infect Dis Poverty. 2020;9(1):78. doi: 10.1186/s40249-020-00689-0.
28. Central Bank of Islamic Republic of Iran [Internet]. Economic Time Series Database 2018. [Cited 16 August 2021]. Available from: https://tsd.cbi.ir/DisplayEn/Content.aspx
29. Social Security Organization [Internet]. Wagetable 2020[Cited 5 February 2021]. Available from: https://www.tamin.ir/
30. Jouzdani J, Shirouyehzad H. Fight against COVID-19: what can be done in the case of Iran? Journal of Applied Research on Industrial Engineering. 2020;7(1):1-12.
31. Statistical Center of Iran [Internet]. National Health Account 2017 2019. [Cited 17 May 2021]. Available from: https://www.amar.org.ir/
32. Liew MF, Siow WT, MacLaren G, See KC. Preparing for COVID-19: early experience from an intensive care unit in Singapore. Crit Care. 2020;24(1):83. doi: 10.1186/s13054-020-2814-x.
33. Murthy S, Gomersall CD, Fowler RA. Care for Critically Ill Patients With COVID-19. JAMA. 2020;323(15):1499-500. doi: 10.1001/jama.2020.3633.
34. Ma X, Vervoort D. Critical care capacity during the COVID-19 pandemic: Global availability of intensive care beds. J Crit Care. 2020;58:96-7. doi: 10.1016/j.jcrc.2020.04.012.
35. Karagiannidis C, Mostert C, Hentschker C, Voshaar T, Malzahn J, Schillinger G, et al. Case characteristics, resource use, and outcomes of 10 021 patients with COVID-19 admitted to 920 German hospitals: an observational study. Lancet Respir Med. 2020;8(9):853-62. doi: 10.1016/S2213-2600(20)30316-7.
36. Guan WJ, Liang WH, He JX, Zhong NS. Cardiovascular comorbidity and its impact on patients with COVID-19. Eur Respir J. 2020;55(6). doi: 10.1183/13993003.01227-2020.
37. Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and meta-analysis. Int J Infect Dis. 2020;10(10.1016).
38. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020;323(20):2052-9. doi: 10.1001/jama.2020.6775
39. Wang B, Li R, Lu Z, Huang Y. Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis. Aging (Albany NY). 2020;12(7):6049-57. doi: 10.18632/aging.103000.
40. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62. doi: 10.1016/S0140-6736(20)30566-3.
41. Barroy H, Wang D, Pescetto C, Kutzin J, Organization WH. How to budget for COVID-19 response? A rapid scan of budgetary mechanisms in highly affected countries. World Health Organization, Geneva. 2020.