Inpatient Costs of Treating Patients With COVID-19

Abstract

Importance: With more than 6.2 million hospitalizations due to COVID-19 in the US, recognition of the average hospital costs to provide inpatient care during the pandemic is necessary to understanding the national medical resource use and improving public health readiness and related policies.

Objective: To examine the mean cost to provide inpatient care to treat COVID-19 and how it varied through the pandemic waves and by important sociodemographic patient characteristics.

Design, setting, and participants: This cross-sectional study used inpatient-level data from March 1, 2020, to March 31, 2022, extracted from a repository of clinical, administrative, and financial information covering 97% of academic medical centers across the US.

Main outcomes and measures: Cost to produce care for each stay was calculated using direct hospital costs to provide care adjusted for geographic differences in labor costs using area wage indices.

Results: The sample included 1 333 404 stays with a primary or secondary COVID-19 diagnosis from 841 hospitals. The cohort included 692 550 (52%) men, with mean (SD) age of 59.2 (17.5) years. The adjusted mean cost of an inpatient stay was $11 275 (95% CI, $11 252-$11 297) overall, increasing from $10 394 (95% CI, $10 228-$10 559) at the end of March 2020 to $13 072 (95% CI, $12 528-$13 617) by the end of March 2022. Patients with specific comorbidities had significantly higher mean costs than their counterparts: those with obesity incurred an additional $2924 in inpatient stay costs, and those with coagulation deficiency incurred an additional $3017 in inpatient stay costs. Stays during which the patient required extracorporeal membrane oxygenation (ECMO) had an adjusted mean cost of $36 484 (95% CI, $34 685-$38 284).

Conclusions and relevance: In this cross-sectional study, an adjusted mean hospital cost to provide care for patients with COVID-19 increased more than 5 times the rate of medical inflation overall. This appeared to be explained partly by changes in the use of ECMO, which increased over time.

Figure 1.. Mean Additional Inpatient Costs, Percentage Needing Extracorporeal Membrane Oxygenation (ECMO) or Mechanical Ventilation, and Mortality Percentage by Comorbidity

The points show the difference in the mean adjusted inpatient costs for patients with and without each comorbidity derived from the generalized linear model adjusted for the same covariates as listed in footnote b of Table 2. The size of the point reflects the percentage of the sample with a given comorbidity (eg, 32% of stays included an obesity diagnosis). The shading of the point reflects the mortality rate of patients with a given comorbidity (eg, 14% of patients with an obesity diagnosis died). Only comorbidities with a statistically significant difference in costs are shown (see full list in eTable 2 in Supplement 1). CVD indicates collagen vascular disease. Data obtained from the Vizient Clinical Data Base, used by permission of Vizient Inc. All rights reserved.

Figure 2.. Mean COVID-19 Inpatient Direct Costs, Unadjusted and Adjusted, and Case and Death Rates Over Time

A, Direct costs of hospitalization. B, Mean number of COVID-19 cases per 100 000 in the patient's county of residence. C, Mean number of deaths due to COVID-19 per 100 000 in the patient's county of residence. The adjusted cost estimates were derived postestimation from the generalized linear model, including the same covariates as listed in footnote b of Table 2. Data obtained from the Vizient Clinical Data Base, used by permission of Vizient Inc. All rights reserved.