Distinct Outcomes in COVID-19 Patients with Positive or Negative RT-PCR Test.

Identification of the SARS-CoV-2 virus by RT-PCR from a nasopharyngeal swab sample is a common test for diagnosing COVID-19. However, some patients present clinical, laboratorial, and radiological evidence of COVID-19 infection with negative RT-PCR result(s). Thus, we assessed whether positive results were associated with intubation and mortality. This study was conducted in a Brazilian tertiary hospital from March to August of 2020. All patients had clinical, laboratory, and radiological diagnosis of COVID-19. They were divided into two groups: positive (+) RT-PCR group, with 2292 participants, and negative (-) RT-PCR group, with 706 participants. Patients with negative RT-PCR testing and an alternative most probable diagnosis were excluded from the study. The RT-PCR(+) group presented increased risk of intensive care unit (ICU) admission, mechanical ventilation, length of hospital stay, and 28-day mortality, when compared to the RT-PCR(-) group. A positive SARS-CoV-2 RT-PCR result was independently associated with intubation and 28 day in-hospital mortality. Accordingly, we concluded that patients with a COVID-19 diagnosis based on clinical data, despite a negative RT-PCR test from nasopharyngeal samples, presented more favorable outcomes than patients with positive RT-PCR test(s).

Unraveling COVID-19-related hospital costs: The impact of clinical and demographic conditions

IntroductionAlthough patients clinical conditions were previously shown to be associated with coronavirus disease 2019 (COVID-19) severity and outcomes, their impact on hospital costs is not known. The economic evaluation of COVID-19 admissions allows the assessment of hospital costs associated with the treatment of these patients, including the main cost components and costs driven by demographic and clinical conditions. The aim of this study was to determine the COVID-19 hospitalization-related costs and their association with clinical conditions. MethodsProspective observational cohort study of the hospitalization costs of patients with COVID-19 admitted between March 30 and June 30, 2020, who were followed until discharge, death, or external transfer, using micro-costing methodology. The study was carried out in the Central Institute of the Hospital das Clinicas, affiliated with the Faculty of Medicine of the University of Sao Paulo, Brazil, which is the largest hospital complex in Latin America and was designated to exclusively admit COVID-19 patients during the pandemic response. ResultsThe average cost of the 3,254 admissions (51.7% of which involved intensive care unit (ICU) stays) was US$12,637.42. Overhead cost was the main cost component, followed by daily fixed costs and drugs. Sex, age and underlying hypertension (US$14,746.77), diabetes (US$15,002.12), obesity (US$18,941.55), cancer (US$10,315.06), chronic renal failure (US$15,377.84), and rheumatic (US$17,764.61), hematologic (US$15,908.25) and neurologic diseases (US$15,257.95) were significantly associated with higher costs. Age >69 years, RT-PCR-confirmed COVID-19, comorbidities, the use of mechanical ventilation, dialysis, or surgery, and poor outcomes remained significantly associated with higher costs after model adjustment. ConclusionKnowledge of COVID-19-associated hospital costs and their impact across different populations can aid in the development of a generalizable and comprehensive approach to hospital preparedness, decision-making and planning for future risk management. Determining the disease-associated costs is the first step in evaluating the cost-effectiveness of treatments and vaccination programs. SUMMARY BOXO_ST_ABSQuestionC_ST_ABSWhat are the COVID-19 hospitalization-related costs? FindingsIn this prospective cohort that was carried out in a single reference quaternary center designated for the treatment of severe cases of COVID-19, more than three thousand patients were included, and their costs of hospitalization were found to be directly related to the age and comorbidities. The costs were more than 50% higher in older patients, 10-24% higher in patients with comorbidities, and 24-200% higher when additional therapeutic procedures were required. MeaningDetermining the disease-associated costs is the first step in conducting future evaluations of the cost-effectiveness of treatments and vaccination programs, supporting their implementation with a comprehensive population-based approach.