Original Article

Comparative Analysis of Costs of Caring for Inpatient COVID-19 Patients and Non-COVID-19 Patients at One Academic Center

Authors: Chi-Cheng Huang, MD, Samuel Rafla, MD, Jacqueline Lippert, MD, Andre Bubnov, MBA, Tareq Islam, MD, MPH

Abstract

Objectives: The coronavirus disease 2019 (COVID-19) pandemic has created a significant financial burden on the US healthcare system. The purpose of this study was to compare the costs of caring for patients admitted with COVID-related illness versus non-COVID patients. We hypothesized that the average daily costs of hospitalization would be higher among COVID patients compared with non-COVID patients.

Methods: This was a retrospective cohort study. Data were downloaded for patients who were admitted at Atrium Wake Forest Baptist Hospital from January 1, 2020 through February 28, 2021. The study population was dichotomized by COVID and non-COVID patients, and the average daily hospital cost was calculated. Multivariate adjusted linear regression models were used to calculate additional “average daily cost” comparisons.

Results: The COVID group was slightly older (mean age 61.0 vs 58.0 years), with longer mean length of stay (6.12 vs 4.95 days) and higher mean average daily direct cost ($1504.01 vs $1341.30) when compared with the non-COVID group, respectively (P < 0.001). After adjusting for various patient characteristics, the direct inpatient cost was $123.00 (95% confidence interval 74.4–171.5) higher per day in patients with COVID-19 (P < 0.0001). When indirect costs are considered, the combined indirect and direct cost may be four times greater.

Conclusions: The average daily direct hospital cost is higher among patients with COVID compared with non-COVID-related illness. Many reasons contributed to this cost difference, including decreased nurse staffing ratios, lower physician censuses, and needed infrastructure changes. Studies with a larger sample size and more precise comparable study groups are warranted to validate our findings.
Posted in: Infectious Disease133

Full Article

Having trouble viewing the article content below? Click here to open it directly.

Images

Download Image

Download Image

Download Image

References

1. Colias M. Auto giants trade drills for tweezers in bid to rush coronavirus ventilators. https://www.wsj.com/articles/ford-and-gm-try-mass-producing-ventilators-can-they-move-fast-enough-11586711800. Published April 12, 2020. Accessed March 23, 2021.
 
2. Sprunt B, Romo V. Pence tests negative for COVID-19; “hundreds of millions” of face masks in production. https://www.npr.org/2020/03/21/817976872/white-house-to-give-an-update-on-coronavirus-tests-response. Published March 21, 2020. Accessed March 23, 2021.
 
3. Best MJ, McFarland EG, Anderson GF, et al. The likely economic impact of fewer elective surgical procedures on US hospitals during the COVID-19 pandemic. Surgery 2020;168:962–967.
 
4. Grimm CA. Hospital experiences responding to the COVID-19 pandemic: results of a national pulse survey March 23–27, 2020. https://oig.hhs.gov/oei/reports/oei-06-20-00300.pdf. Published April 2020. Accessed March 23, 2021.
 
5. Bai G, Zare H. Hospital cost structure and the implications on cost management during COVID-19. J Gen Intern Med 2020;35:2807–2809.
 
6. Barnett ML, Mehrotra A, Landon BE. Covid-19 and the upcoming financial crisis in health care. https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0153. Published April 29, 2020. Accessed March 20, 2021.
 
7. Health Resources and Services Administration. Provider relief fund past payments. https://www.hrsa.gov/provider-relief/payments-and-data/past-payments/targeted-distribution [hrsa.gov]Past Targeted Distributions | HRSA [hrsa.gov] .
 
8. Khullar D, Bond AM, Schpero WL. COVID-19 and the financial health of US hospitals. JAMA 2020;323:2127.
 
9. Institute of Medicine. America’s health care safety net: intact but endangered. https://nap.nationalacademies.org/catalog/9612/americas-health-care-safety-net-intact-but-endangered. Published 2000. Accessed July 26, 2021.
 
10. Mackey K, Ayers CK, Kondo KK, et al. Racial and ethnic disparities in COVID-19-related infections, hospitalizations, and deaths: a systematic review. Ann Intern Med 2021;174:362–373.
 
11. Tsai Y, Vogt T, Zhou F. Patient characteristics and costs associated with COVID-19-related medical care among Medicare fee-for-service beneficiaries. Ann Intern Med 2021;174:1101-1109.
 
12. Wang Y, Bai G, Anderson G. COVID-19 and hospital financial viability in the United States. JAMA Health Forum 2022;3:e221018.
 
13. Bartsch S, Ferguson M, McKinnell JA, et al. The potential health care costs and resource use associated with COVID-19 in the United States. Health Affairs (Millwood) 2020;39:927-935.
 
14. FAIR Health. The projected economic impact of the COVID-19 pandemic on the US healthcare system. https://www.fairhealth.org/search?cx= 000501718051952632208:zzp-h8yyn9e&q=The%20Projected%20Economic %20Impact%20of%20the%20COVID-19%20Pandemic%20on%20the% 20the%20US%20Healthcare%20System&sa=searchterm&cof=FORID:10. Published March 20, 2020. Accessed March 20, 2021.