COVID-19 in real world: Survival and medical costs of hospitalized patients in Brazils first wave

Rocha, Jaime Luís Lopes; Riediger, Irina; Gasparetto, Juliano; Tuon, Felipe Francisco

doi:10.1016/j.bjid.2023.102778

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Brazilian Journal of Infectious Diseases

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Sumário

Original Article • Braz J Infect Dis 27 (4) • 2023 • https://doi.org/10.1016/j.bjid.2023.102778 copy

COVID-19 in real world: Survival and medical costs of hospitalized patients in Brazils first wave

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To evaluate survival and direct medical costs of patients admitted in private hospitals with COVID-19 during the first wave.

Methods:

A retrospective, observational study analyzing survival and the economic data retrieved on hospitalized patients with COVID-19. Data from March 2020 to December 2020. The direct cost of hospitalization was estimated using the microcosting method with each individual hospitalization.

Results:

342 cases were evaluated. Median age of 61.0 (95% CI 57.0-65.0). 194 (56.7%) were men. The mortality rate was higher in the female sex (p = 0.0037), ICU (p < 0.001), mechanical ventilation (p<0.001) and elderly groups. 143 (41.8%) patients were admitted to the ICU (95% CI 36.6%-47.1%), of which 60 (41.9%) required MV (95% CI 34.0%-50.0%). Global LOS presented median of 6.7 days (95% CI 6.0-7.2). Mean costs were US$ 7,060,00 (95% CI 5,300.94-8,819,00) for each patient. Mean cost for patients discharged alive and patients deceased was US$ 5,475.53 (95% CI 3,692.91-7,258.14) and US$ 12,955.19 (95% CI 8,106.61 -17,803.76), respectively (p < 0.001).

Conclusions:

Patients admitted with COVID-19 in these private hospitals point to great economic impact, mainly in the elderly and high-risk patients. It is key to better understand such costs in order to be prepared to make wise decisions during the current and future global health emergencies.

Keywords:
COVID-19; Brazil; Survival; Cost; Microcosting; Burden of disease; Economic burden

		Final outcome
		Discharged n (n%) or Median (95% Cl)	Death n (n%) or Median (95% Cl)	Total n (n%) or Median (95% Cl)
Gender	Female	110 (40.4%)	38 (54.2%)	Total n (n%) or Median (95% Cl)		148 (43.2%)	p = 0.037
	Male	162 (59.5%)	32 (45.7%)	194 (56.7%)
Age Group	Age in years	55.0 (52.0–58.0)	83.0 (80.0–86)	61.0 (57.0–65.0)	p < 0.001
	18 to 40	57 (20.9%)	0	57 (16.6%)	p < 0.001
	41 to 60	105 (38.6%)	5 (7.1%)	110 (32.1%)
	61 to 80	91 (33.4%)	24 (34.2%)	115 (33.6%)
	Above 80	19 (6.9%)	41 (58.5%)	60 (17.5%)
	LOS in days	6.1 (5.6–6.8)	8.8 (7.7–11.7)	6.7 (6.0–7.2)	p < 0.001
	ICU	96 (67.2%)	47 (32.9%)	143 (100%)	p < 0.001
	LOS in ICU in days^a a For patients admitted to ICU (not all patients).	3.0 (2.8–49)	8.5 (5.9–13.5)	4.7 (3.4–6.4)	p < 0.001
	MV	21 (35.0%)	39 (65.0%)	60 (100%)	p < 0.001
	LOS in MV in days^b b For patients in MV (not all patients) Smoking (actual or past).	9.1 (5.5–169)	8.8 (5.9–12.2)	8.9 (7.0–12.2)	p < 0.001
Comorbidities	HBP	109 (40.0%)	40 (57.1%)	149 (43.5%)	p = 0.010
	DM	70 (25.7%)	13 (18.5%)	83 (24.2%)	p = 0.213
	Cardiopathy	46 (16.9%)	23 (32.8%)	69 (20.1%)	p = 0.003
	NeuroPsiq	40 (14.7%)	13 (18.5%)	53 (15.5%)	p = 0.426
	Dementia	12 (4.4%)	30 (42.6%)	42 (12.8%)	p < 0.001
	Dyslipidemia	34 (12.5%)	8 (11.4%)	42 (12.8%)	p = 0.807
	COPD	19 (6.9%)	18 (25.7%)	37 (10.8%)	p < 0.001
	Obesity	25 (9.1%)	8 (11.4%)	33 (9.6%)	p = 0.572
	Hypothyroidism	21 (7.7%)	4 (5.7%)	25 (7.3%)	p = 0.213
	ARF	10 (3.6%)	13 (18.5%)	23 (6.7%)	p < 0.001
	Neoplasia	12 (4.4%)	9 (12.8%)	21 (6.1%)	p = 0.009
	CRF	12 (4.4%)	5 (7.1%)	17 (4.9%)	p = 0.349
	CHF	6 (2.2%)	10 (14.2%)	16 (4.6%)	p < 0.001
	Smoking	13 (4.7%)	2 (2.8%)	15 (4.3%)	p = 0.484
	Immunodeficiency^c c Including HIV, use of immunosuppressors; p-value based on Mann-Whitney U on Kruskal Wallis test for independent samples. 95% CI, 95% Confidence Interval; ICU, Intensive Care Unit; MV, Mechanical Ventilation; LOS, Length of Stay; CHF, Cardiac Heart Failure; HBP, High Blood Pressure; DM, Diabetes Mellitus; COPD, Chronic Obstructive Pulmonary Disease; ARF, Acute Renal Failure; CRF, Chronic Renal Failure; HAP, Hospital Acquired Pneumonia; C. Diff, Clostridium Difficile; UTI, Urinary Tract Infection.	6 (2.2%)	0	6 (1.7%)	p = 0.210
Total number of comorbidities	None	99 (36.3%)	2 (2.8%)	101 (29.5%)	p < 0.001
	1	51 (18.7%)	10 (14.2%)	61 (17.8%)
	2	54 (19.8%)	19 (27.1%)	73 (21.3%)
	3 or more	68 (25.0%)	39 (55.7%)	107 (31.2%)
Complications	Phebitis	22 (8.0%)	11 (15.7%)	33 (9.6%)	p = 0.054
	Pressure Ulcer	7 (2.5%)	18 (25.7%)	25 (7.3%)	p < 0.001
	Sepsis	11 (4.4%)	13 (18.5%)	24 (7.0%)	p < 0.001
	HAP	3 (1.1%)	8 (11.4%)	11 (3.2%)	p < 0.001
	UTI	2 (0.7%)	1 (1.4%)	3 (0.8%)	p = 0.579
	Fall	2 (0.7%)	0	2 (0.5%)	p = 0.472
	Pneumothorax	1 (0.3%)	1 (1.4%)	2 (0.5%)	p = 0.299
	C.diff. Infection	2 (0.7%)	0	2 (0.5%)	p = 0.472
Total number of Complications	None	238 (87.5%)	42 (60.0%)	280 (81.8%)	p < 0.001
	1	24 (8.8%)	14 (20.0%)	38 (11.1%)
	2 or more	10 (3.6%)	20 (28.5%)	24 (7.0%)
Procedures	Hemodyalisis	6 (2.2%)	14 (20.0%)	20 (5.8%)	p< 0.001
	Tracheostomy	6 (2.2%)	7 (10.0%)	13 (3.8%)	p = 0.002
	Transfusion	3 (1.1%)	6 (8.5%)	9 (2.6%)	p< 0.001
	Pleural drainage	1 (0.3%)	4 (5.7%)	5 (1.4%)	p< 0.001
Total number of procedures	None	258 (94.8%)	47 (67.1%)	305 (89.1%)	p< 0.001
	1	12 (4.4%)	17 (24.2%)	29 (8.4%)
	2 or more	2 (0.7%)	6 (8.5%)	8 (2.3%)
Total		272 (79.5%)	70 (20.4%)	342 (100%)

	B	SE	P	Exp(B)	Exp(B) 95% CI
	B	SE	P	Exp(B)	Inferior	Superior
Age	0.151	0.034	0.000	1.162	1.087	1.243
LOS	-0.264	0.065	0.000	0.768	0.677	0.872
MV	4.458	1.032	0.000	86.297	11.428	651.685
LOS in ICU	0.197	0.076	0.010	1.217	1.049	1.413
Dementia	2.817	0.744	0.000	16.730	3.891	71.933
COPD	2.936	0.846	0.001	18.831	3.590	98.785
Pressure Ulcer	2.855	1.206	0.018	17.377	1.636	184.558
Transfusion	3.397	1.388	0.014	29.889	1.967	454.222
Hemodyalisis	3.594	1.115	0.001	36.370	4.089	323.522
Constant	-13.607	2.740	0.000	0.000

			COSTS in USS
			Discharged Median (95% Cl)	Death Median (95% Cl)	Total Median (95% Cl)
Gender^b b p = 0.004).	Female	2088.46 (1692.25–2849.99)	5773.58 (3855.02–9363.24)	2849.99 (2155.15–3714.52)	p<0.001
Male	1473.56 (1301.87–1885.83)	4845.16 (2940.21–15,988.14)	1816.34 (1414.38–2232.29)	p<0.001
Age Group^a a p< 0.001.	18 to 40	1377.33 (935.55–2020.60)	–	1377.33 (935.55–2020.60)	–
	41 to 60	1749.44 (1345.85–1927.82)	15,955.13 (15,592.95–53,724.14)	1816.34 (1432.69–2021.77)	p<0.001
	61 to 80	1808.83 (1402.69–3122.61)	7051.29 (4618.88–23,488.41)	2722.95 (1707.87–3848.95)	p<0.001
	Above 80	4498.82 (1976.67–7476.60)	3813.76 (2832.86–6009.13)	3861.82 (2849.99–5799.23)	p = 0.946
ICU^a a p< 0.001.	Non-admitted	1245.52 (1034.40–1377.33)	2368.55 (1781.72–3060.10)	1321.52 (1148.21–1432.69)	p<0.001
	Admitted	4838.18 (3654.89–6217.29)	11,589.96 (6389.92–15,988.14)	6118.69 (4958.47–7421.93)	p = 0.001
MV^a a p< 0.001.	Non-submitted	1661.62 (1402.69–1846.98)	2607.23 (1969.45–3714.52)	1752.47 (1473.56–1907.94)	p = 0.006
	Submitted	23,776.69 (11,294.61–50,553.79)	13,887.08 (9524.22–21,676.50)	15,790.54 (11,589.97–22,485.54)	p = 0.076
Total number of Comorbidities^a a p< 0.001.	None	1807.94 (1432.69–2021.77)	18,713.77 (4845.17–32,583.38)	1824.75 (1433.70–2050.97)	p = 0.032
	1	1385.99 (1021.40–1705.56)	4179.68 (1569.00–9363.24)	1533.23 (1211.99–1885.83)	p = 0.009
	2	1426.53 (1148–2569.12)	7385.97 (3815.56–23,596.21)	2480.06 (1429.77–3738.47)	p<0.001
	3 or more	3256.44 (1744.71–5002.24)	4788.67 (2940.21–7421.93)	3630.15 (2855.00–5122.49)	p = 0.047
Total number of Complications^a a p< 0.001.	None	1533.23 (1373.83–1807.95)	3060.09 (2368.56–5119.55)	1752.47 (1489.29–1908.96)	p<0.001
	1	7670.51 (4553.87–11,294.61)	11,589.96 (3855.02–38,726.75)	8999.25 (4553.87–11,589.97	p = 0.462
	2	26,634.91 (14,702.51–50,553.79)	19,894.71 (13,887.08–33,574.03)	22,636.35 (15,168.25–32,582.37)	p = 0,616
Total number of Procedures^a a p< 0.001.	None	1717.02 (1423.30–1892.02)	3714.52 (2832.86–6009.13)	1865.64 (1692.25–2155.15)	p = 0.082
	1	25,396.33 (9066.07–64,280.24)	11,589.96 (4958.47–18,112.93)	14,937.61 (9066.07–23,596.21)	p = 0.082
	2 or more	25,976.42 (1399.05–50,553.79)	33,584.33 (22,485.54–53,724.14)	33,584.33 (15,592.94–53,724.13)	p = 0.643
Total		1793.33 (1489.29–1976.67)	5446.56 (3815.56–7421.93)	2113.99 (1847.79–2609.59)	p<0.001

Patient Acomodation	Daily Cost in US$
Global Daily Cost	728.46
GMW daily cost	297.53
ICU daily cost	969.72
ICU daily cost without MV	567.40
ICU daily cost with MV	1223.89

Brazilian Society of Infectious Diseases Rua Augusto Viana, SN, 6º., 40110-060 Salvador - Bahia - Brazil, Telefax: (55 71) 3283-8172, Fax: (55 71) 3247-2756 - Salvador - BA - Brazil
E-mail: bjid@bjid.org.br

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[1] ⁎Corresponding author. E-mail address: felipe.tuon@pucpr.br (F.F. Tuon).