Analysis of the direct and indirect costs of COVID-19 in a Brazilian hospital

Abstract

Objective: To evaluate the direct costs from the hospital and Unified Health System (SUS) perspective, as well as the indirect costs of patients hospitalized by COVID-19. Methods: Observational study with data collection by micro- and macro-costing, carried out with patients hospitalized in a hospital in São Paulo (March-September 2020). Indirect costs were obtained using human capital and disability-adjusted life years (DALY) methods. Mann-Whitney and linear regression analyzes were performed. Results: 158 individuals were included, with a median age of 57 years (IQR 42- 68 years). The median cost of admission in the SUS and hospital perspective was, respectively, R$ 2,009.46 (IQR: R$ 1,649.11; R$ 4,847.36), mainly due to the intensive care unit (ICU) and R$ 19,055.91 (IQR: R$ 8,399.47; R$ 38,438.00), mainly due to human resources. The total length of stay in hospital (p < 0.001), death (p < 0.001) and invasive ventilation (p < 0.001) were predictors of cost increase. A loss of 381.5 DALY and a loss of productivity of 128 years were identified, equivalent to US$ 855,307. Conclusion: The cost drivers were human resources and use of the ICU. However, it was from the perspective of society that the greatest impact was identified due to the loss of productivity and DALY. The length of hospital stay was one of the major contributors to the cost of hospitalization and this factor may be linked to the severity of the disease and patient care protocols.