Cost of Illness in Patients With COVID-19 Admitted in Three Brazilian Public Hospitals.

OBJECTIVES: The severity and transmissibility of COVID-19 justifies the need to identify the factors associated with its cost of illness (CoI). This study aimed to identify CoI, cost predictors, and cost drivers in the management of patients with COVID-19 from hospital and Brazil's Public Health System (SUS) perspectives. METHODS: This is a multicenter study that evaluated the CoI in patients diagnosed of COVID-19 who reached hospital discharge or died before being discharged between March and September 2020. Sociodemographic, clinical, and hospitalization data were collected to characterize and identify predictors of costs per patients and cost drivers per admission. RESULTS: A total of 1084 patients were included in the study. For hospital perspective, being overweight or obese, being between 65 and 74 years old, or being male showed an increased cost of 58.4%, 42.9%, and 42.5%, respectively. From SUS perspective, the same predictors of cost per patient increase were identified. The median cost per admission was estimated at US$359.78 and US$1385.80 for the SUS and hospital perspectives, respectively. In addition, patients who stayed between 1 and 4 days in the intensive care unit (ICU) had 60.9% higher costs than non-ICU patients; these costs significantly increased with the length of stay (LoS). The main cost driver was the ICU-LoS and COVID-19 ICU daily for hospital and SUS perspectives, respectively. CONCLUSIONS: The predictors of increased cost per patient at admission identified were overweight or obesity, advanced age, and male sex, and the main cost driver identified was the ICU-LoS. Time-driven activity-based costing studies, considering outpatient, inpatient, and long COVID-19, are needed to optimize our understanding about cost of COVID-19.

Hospitalization costs of coronaviruses diseases in upper-middle-income countries: A systematic review.

BACKGROUND: COVID-19, SARS and MERS are diseases that present an important health burden worldwide. This situation demands resource allocation to the healthcare system, affecting especially middle- and low-income countries. Thus, identifying the main cost drivers is relevant to optimize patient care and resource allocation. OBJECTIVE: To systematically identify and summarize the current status of knowledge on direct medical hospitalization costs of SARS, MERS, or COVID-19 in Upper-Middle-Income Countries. METHODS: We conducted a systematic review across seven key databases (PubMed, EMBASE, BVS Portal, CINAHL, CRD library, MedRxiv and Research Square) from database inception to February 2021. Costs extracted were converted into 2021 International Dollars using the Purchasing Power Parity-adjusted. The assessment of quality was based on the protocol by the BMJ and CHEERS. PROSPERO 2020: CRD42020225757. RESULTS: No eligible study about SARS or MERS was recovered. For COVID-19, five studies presented cost analysis performed in Brazil, China, Iran, and Turkey. Regarding total direct medical costs, the lowest cost per patient at ward was observed in Turkey ($900.08), while the highest in Brazil ($5,093.38). At ICU, the lowest was in Turkey ($2,984.78), while the highest was in China ($52,432.87). Service care was the most expressive (58% to 88%) cost driver of COVID-19 patients at ward. At ICU, there was no consensus between service care (54% to 87%) and treatment (72% to 81%) as key burdens of total cost. CONCLUSION: Our findings elucidate the importance of COVID-19 on health-economic outcomes. The marked heterogeneity among studies leaded to substantially different results and made challenging the comparison of data to estimate pooled results for single countries or regions. Further studies concerning cost estimates from standardized analysis may provide clearer data for a more substantial analysis. This may help care providers and policy makers to organize care for patients in the most efficient way.

Rational use of chloroquine and hydroxychloroquine in times of COVID-19

Considering the COVID-19 pandemic declared, part of the researchers'efforts has been in studies of repurposing chloroquine (CQ) and hydroxychloroquine (HCQ), cheap medicines that have been used for decades with indication for malaria, rheumatoid arthritis and systemic lupus erythematosus. Chinese and South Korean health officials recommended the use of QC and HCQ for prophylaxis and treatment of COVID-19, encouraging researchers around the world to assess the potential of these medicines as antivirals. To date, results of three clinical trials have been released. Two studies show divergent results for virological clearance, while the third suggests a benefit in terms of radiological and clinical improvement. The three studies have methodological limitations and low overall quality of evidence, in view of the absence of randomization, allocation concealment, blinding patients, health care providers, and outcome assessors, missing data and/or selective reporting of results, as well as probable heterogeneity of patients and treatments, imprecision due to the reduced statistical power of the studies, indirect evidence for patients with severe form of the disease or patients with high severity comorbidities. The irresponsible self-medication of these medicines is of concern both for the potential risk of shortages, as well as for the adverse events and potentially fatal intoxications. Thus, in the USA, Europe and Brazil, regulatory agencies have positioned themselves in an emergency, authorizing the use of CQ and HCQ under medical criteria and/or in the context of clinical trials. In Brazil, to restrict irresponsible self-medication and possible shortages, Anvisa included the drugs in a special control list. Evidence on the efficacy and safety of QC and HCQ remains uncertain, so the results of ongoing studies are needed to adequately guide public policy and clinical practice. Evidence-based health assumptions must be maintained even in times of international emergency due to the risk of having to deal with future complications from the irrational use of these medicines.