ABSTRACT
BACKGROUND: Healthcare costs in 2020 increased 9.7% from the prior year reaching $4.1 trillion dollars. This increase was much higher than the 4.3% rate increase between 2018 and 2019 and considered to be largely attributed to federal expenditures in response to the COVID-19 pandemic. Limited information exists on costs attributed to the pandemic as response continues. The objective of this study was to understand hospitalization costs attributed to COVID-19 within the Veterans Administration (VA) and Department of Defense (DoD). METHODS: Data on hospitalizations within the VA and DoD with a primary diagnosis of COVID-19 were investigated to understand differences in total cost, cost per day, and length of stay by location, age, sex, and Medicare Severity Diagnosis Related Groups (MS-DRGs). 7,818 hospitalizations occurred at VA facilities, while 773 occurred at DoD facilities. 74.7% of the hospitalizations were attributed to respiratory infections and inflammation with major complication or comorbidity (MS-DRG 177).Generalized linearmodels using a gamma distribution for total cost and cost per day and Poisson distribution for length of stay were run to investigate outcomes of overall and byMS-DRG.RESULTS: In the full sample, cost did not differ by location (VA vs. DoD) or sex, however, those aged 71-76 cost on average $537 more than those ages 19-59 (537.67, 95%CI 34.67,1029.68). Length of stay was nearly 3 days shorter for DoD hospitalizations (-2.99, 95%CI -3.54,-2.34) and length of stay increased as age increased with those 77 years and older staying over 8 days longer than those aged 19-59 (8.70, 95%CI 5.04, 12,35). Total costs per day were lower for hospitalizations at DoD facilities (-521.96, 95%CI -718.40,-325.51) and for those aged 77 and above compared to those aged 19- 59 (-317.41, 95%CI -478.61,-156.21). Similar patterns existed when hospitalizations were stratified by MS- DRG, except that in hospitalizations for respiratory infections and inflammation with major complication or comorbidity total costs were $730 higher at DoD compared to the VA (729.99, 95%CI 296.53,1163.47) despite the cost per day remaining lower for DoD (-574.87, 95%CI -804.07,-345.68). CONCLUSIONS: Overall, total costs for hospitalizations from COVID-19 were similar at VA and DoD locations, however, length of stay and costs per day were lower for DoD. When investigating only hospitalizations with major complications or comorbidity, total costs were higher for the DoD, but length of stay and cost per day remained lower compared to the VA. Differences existed by age but not by sex.