Comparison of COVID-19 hospitalization costs across care pathways: a patient-level time-driven activity-based costing analysis in a Brazilian hospital

Economic impact and disease burden of COVID-19 in a tertiary care hospital: A three-year analysis

BACKGROUND

The COVID-19 pandemic has increased morbidity and mortality, along with substantial economic repercussions for healthcare systems and communities worldwide. This study describes the costs incurred by one of the biggest university hospitals in Finland during the first three years of the pandemic, from 2020 to 2022.

METHODS

A retrospective analysis was conducted at a 950-bed tertiary care hospital, encompassing data from 2020 to 2022. Hospitalized COVID-19 cases were identified from an automated surveillance program that integrated microbiological and administrative data. Patient-level data, including hospitalization demographics, vaccination status, and outcomes, were collected. Billing costs, indirect costs, and operational data were obtained to assess hospital costs comprehensively.

RESULTS

During 2020-2022, 2 555 COVID-19-positive patients were treated at the hospital. Of them, 57% were hospitalized primarily for COVID-19 with the hospital billing costs of 14 492 399 € (median 4 137 €/ patient), and 47% of these costs were due to intensive care. Including ER visits of COVID-19 outpatients, admission screening and isolation costs of COVID-19 positive patients hospitalized for other reasons and indirect expenses, the total costs reached 28 899 298 € over three years. Additionally, the hospital incurred losses of income due to postponed elective surgeries.

DISCUSSION

The economic burden of COVID-19 at the considered university hospital was substantial. Intensive care costs were a significant driver. This study provides a comprehensive overview of the economic and disease burden of COVID-19 at a tertiary care hospital, highlighting the need for strategic planning and financial readiness to address the costs associated with pandemics.

Evaluation of In-Hospital and Community-Based Healthcare Utilization and Costs During the Coronavirus 2019 (COVID-19) Pandemic in Alberta, Canada: A Population-Based Descriptive Study

Background

Assessing the financial burden of COVID-19 is important for planning health services and resource allocation to inform future pandemic response.

Objectives

This study examines the changing dynamics in healthcare utilization patterns and costs from a public healthcare perspective during the COVID-19 pandemic in Alberta, Canada.

Design

Population-based descriptive study.

Methods

All adult patients over the age of 18 years who had a laboratory-confirmed COVID-19 diagnosis in Alberta, Canada from March 1, 2020 to December 15, 2021. We described demographic information and community- and hospital-based healthcare utilization and costs. We compared changes in each outcome throughout the first four waves of the pandemic.

Results

Among 255,037 patients, hospitalization incurred significantly higher costs (N = 20,603; aRR = 755.51; marginal cost: $21,738.17 CAD; P < .01). Wave 2 recorded the highest cost for Emergency Department (ED) visits (aRR = 1.10; marginal cost: $79.19 CAD; P < .01). Compared to Wave 1, Waves 2-4 all recorded significantly lower costs for out-patient visits. Wave 2's in-patient cost for patients that required ICU admission was significantly lower than Wave 1 (aRR = 0.75; marginal cost: -$24,142.47 CAD; P = .02).

Conclusion

COVID-19 exerted a heavy toll on healthcare services, and the dynamics of this continue to evolve. Utilization of ED and in-patient services were particularly high. Severe infections requiring hospitalization and ICU admission are more expensive than non-hospitalized and non-ICU hospital admits. Future studies should clarify specific factors, such as sociodemographic determinants, that contribute to evolving patterns of health services consumption and changing trends in cost to holistically inform responses to future pandemics.

Cost-effectiveness and postoperative outcomes of spontaneous vs. mechanical ventilation during video-assisted thoracoscopic surgery: a retrospective study

Background

Video-assisted thoracoscopic surgery (VATS) is known to have the advantages of being minimally invasive, reducing complications, and shortening hospitalization time. However, related cost surveys have been inconsistent. In recent years, a new concept of tubeless anesthesia has been introduced, but its impact on the cost-effectiveness of VATS is unclear. This study compared the hospitalization costs and postoperative outcomes in patients undergoing spontaneous ventilation VATS (SV-VATS) and mechanical ventilation VATS (MV-VATS).

Methods

We retrospectively analyzed data on the VATS procedures performed at the Shaoxing People's Hospital from June 2022 to July 2023. Overall, 386 patients who met the inclusion criteria were treated with SV-VATS (n=57) or MV-VATS (n=329). Comprehensive cost comparisons were performed between the groups.

Results

The two groups shared comparable clinical characteristics, such as age (P=0.64), sex (P=0.72), body mass index (BMI) (P=0.68), and type of procedure (P=0.43). All costs are expressed in U.S. dollars ($). The overall, diagnostic, operation, and material costs of SV-VATS and MV-VATS were $3,858.71±$746.32 vs. $3,870.26±$990.69 (P=0.94), $911.83 vs. $908.73 (P=0.51), $875.58 vs. $875.58 (P=0.51), and $1,560.5 vs. $1,596.91±$727.18 (P=0.31), respectively. In addition, the median costs of anesthesia materials and total medications were $233.51 vs. $324.02 and $290.63 vs. $364.14, respectively (P<0.001). Among medications, the cost of anesthesia medicine was $179.6±$45.48 vs. $224.12±$54.67, respectively (P<0.001). Postoperative complications, including sore throat, hoarseness, and expectoration, did not occur in the SV-VATS group, whereas 13, 11, and 10 cases were noted, respectively, in the MV-VATS group (13.5%, 11.5%, and 10.4%, respectively; P=0.01, P=0.03, P=0.041). The time to extubation in the SV-VATS and MV-VATS groups was 4 and 10 min, respectively (P<0.001). No intermediate surgery was performed in either group.

Conclusions

Compared with SV-VATS, MV-VATS can reduce patients' anesthesia and medicine costs and has similar postoperative adverse event rates in VATS patients, which is conducive to accelerating patient recovery. Therefore, tubeless anesthesia is recommended for future VATS.

Economic Evaluation of Novel Models of Care for Patients With Acute Medical Problems

Importance

During COVID-19, Singapore simultaneously experienced a dengue outbreak, and acute hospitals were under pressure to lower bed occupancy rates. This led to new models of care to treat patients with acute, low-severity medical conditions either at home, in a hospital-at-home (HaH) model, or in a clinic-style setting sited at the emergency department in an ambulatory care team (ACT) model, but a reliable cost analysis for these models is lacking.

Objective

To compare personnel costs of HaH and ACT with inpatient care.

Design, Setting, and Participants

In this economic evaluation study, time-driven activity-based costing was used to compare the personnel cost of inpatient care with treating dengue via HaH and treating chest pain via ACT. Participants were patients with nonsevere dengue and chest pain unrelated to a coronary event admitted via the emergency department to the internal medicine service of a tertiary hospital in Singapore.

Exposures

HaH for dengue and ACT for chest pain.

Main Outcomes and Measures

A process map was created for the patient journey for a typical patient with each condition. The amount of time personnel spent on delivering care was estimated and the cost per minute determined based on their wages in 2022. The total cost of care was calculated by multiplying the time spent by the per-minute cost of the personnel resource and summing all costs.

Results

Compared with inpatient care, HaH used 50% less nursing time (418 minutes, 95% uncertainty interval [UI], 370 to 465 minutes) but 80% more medical time (303 minutes, 95% UI, 270 to 338 minutes) per case of dengue. If implemented nationally, HaH would save an estimated 56 828 SGD per year (95% UI, -169 497 to 281 412 SGD [US $41 856; 95% UI, -$124 839 to $207 268]). The probability that HaH is cost saving was 69.2%. Compared with inpatient care, ACT used 15% less nursing time (296 minutes, 95% UI, 257 to 335 minutes) and 50% less medical time (57 minutes, 95% UI, 46 to 69 minutes) per case of chest pain. If implemented nationally, ACT would save an estimated 1 561 185 SGD per year (95% UI, 1 040 666 to 2 086 518 SGD [US $1 149 862; 95% UI, $766 483 to $1 536 786]). The probability that ACT is cost saving was 100%.

Conclusions and Relevance

This economic evaluation found that the HaH and ACT models decreased the overall personnel cost of care. Reorganizing hospital resources may help hospitals reap the benefits of reduced hospital-acquired infections, improved patient recovery, and reduced hospital bed occupancy rates.

Burden of COVID-19 during the omicron predominance in Brazil: a nationwide retrospective database study

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has imposed significant burden on Brazil's health system. This study aimed to examine clinical characteristics, overall vaccine uptake, and to assess healthcare resource utilization (HCRU) and costs associated with acute COVID-19 in Brazil during the Omicron predominant period.

METHODS

A nationwide retrospective study was conducted using various Brazilian databases including, COVID-19 related databases, public health systems, and other surveillance/demographic datasets. Individuals with positive COVID-19 test results between January 1 2022 and April 30 2022, during Omicron BA.1/BA.2 wave, were identified. Patients' demographics, vaccine uptake, HCRU and corresponding costs were described by age groups.

RESULTS

A total of 8,160,715 (3.80%) COVID-19 cases were identified in the study cohort, ranging from 2.43% in <5 years to 62.05% in 19-49 years. The uptake of partial (Dose 1) or full immunization (Dose 2) was less than 0.1% in children aged <5 years, whereas in individuals ≥ 19 years, it exceeded 89.78% for Dose 1 and 84.07% for Dose 2. Overall booster vaccine uptake was 38.06%, which was significantly higher among individuals aged ≥ 65 years, surpassing 74.79%. Regardless of vaccination status, 87.2% cases were symptomatic, and 1.48% were hospitalized due to acute COVID-19 (<5 years: 2.33%, 5-11 years: 0.99%, 12-18 years: 0.32%, 19-49 years: 0.40%; 50-64 years: 1.50%, 65-74 years: 5.43%, and ≥ 75 years: 17.89%). Among the hospitalized patients (n = 120,450), 32.57% were admitted to ICU, of whom 31,283 (79.75%) individuals required mechanical ventilation (MV) support. The average cost per day in normal ward and ICU without MV in public/general hospital settings was $104.36 and $302.81, respectively. While average cost per day in normal ward and ICU with MV was $75.91 and $301.22 respectively.

CONCLUSIONS

This study quantified the burden of COVID-19 in Brazil, suggesting substantial healthcare resources required to manage the COVID-19 pandemic.