A repeated cross-sectional analysis on the economic impact of SARS-CoV-2 pandemic at the hospital level in Italy

Abstract

Italy was the first country in Europe to be hit by the Severe Acute Respiratory Syndrome Coronavirus 2. Little research has been conducted to understand the economic impact of providing care for SARS-CoV-2 patients during the pandemic. Our study aims to quantify the incremental healthcare costs for hospitalizations associated to being discharged before or after the first SARS-CoV-2 case was notified in Italy, and to a positive or negative SARS-CoV-2 notified infection. We used data on hospitalizations for 9 different diagnosis related groups at a large Italian Research Hospital with discharge date between 1st January, 2018 and 31st December 2021. The median overall costs for a hospitalization increased from 2410EUR (IQR: 1588-3828) before the start of the pandemic, to 2645EUR (IQR: 1885-4028) and 3834EUR (IQR: 2463-6413) during the pandemic, respectively for patients SARS-CoV-2 negative and positive patients. Interestingly, according to results of a generalized linear model, the highest increases in the average costs sustained for SARS-CoV-2 positive patients with respect to patients discharged before the pandemic was found among those with diagnoses unrelated to COVID-19, i.e. kidney and urinary tract infections with CC (59.71%), intracranial hemorrhage or cerebral infarction (53.33), and pulmonary edema and respiratory failure (47.47%). Our study highlights the economic burden during the COVID-19 pandemic on the hospital system in Italy based on individual patient data. These results contribute to the to the debate around the efficiency of the healthcare services provision during a pandemic.

Figure 1

Distribution of costs (in EUR). Distribution of sustained cost for patients hospitalized for intracranial hemorrhage or cerebral infarction (014) (A), respiratory infections and inflammations with (079) (B) or without (080) (C) CC, pulmonary edema and respiratory failure (087) (D), simple pneumonia and pleurisy with (089) (E) and without (090) (F) CC, kidney and urinary tract infections with CC (320) (G), respiratory system diagnosis with ventilator support >  = 96 (565) (H) or < 96 h (566) (I), discharged in the pre-pandemic period (yellow), during the pandemic without a diagnosis for SARS-COV-2 (blue), and during the pandemic with a diagnosis for SARS-COV-2 (red).

Figure 2

Stratification of costs. Median total costs stratified by different types of resources used for patients hospitalized for intracranial hemorrhage or cerebral infarction (A), respiratory infections and inflammations with (B) or without (C) CC, pulmonary edema and respiratory failure (D), simple pneumonia and pleurisy with (E) and without (F) CC, kidney and urinary tract infections with CC (G), respiratory system diagnosis with ventilator support >  = 96 (H) or < 96 h (I).

Figure 3

Results of the generalized linear model on the total costs. Average percentage increase/reduction of hospitalization costs for patients discharged during the pandemic with a positive or negative SARS-CoV-2 diagnosis with respect to patients discharged before the pandemic. Let ${\beta }_{\mathit{group}}$ denote the coefficient relative to the variable defining patients subgroups, such variations are obtained as $100\ast \left({exp}^{{\beta }_{\mathit{group}}}\right)$.