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Stationäre Kosten für die Behandlung von COVID-19 in den USA

von NFI Redaktion

Recently, a study published in JAMA Network Open discussed the average costs of inpatient care for patients with Coronavirus Disease 2019 (COVID-19). The study also looked at how these costs varied during different pandemic waves and due to specific patient sociodemographic characteristics.

Study: Inpatient costs of treating COVID-19 in the U.S.

Studie: Stationäre Kosten für die Behandlung von Patienten mit COVID-19. Bildnachweis: 9dream Studio / Shutterstock.com

Hintergrund

The COVID-19 pandemic has placed an unprecedented burden on global healthcare. As of the end of 2022, COVID-19 was responsible for nearly 6.7 million deaths, with cases exceeding 660 million worldwide.

In the United States, the demand for hospital services peaked during the rise of the Omicron variant between November 2021 and February 2022. However, this demand could not be met due to personnel, medication, and equipment shortages, leading to the cancellation of surgeries. To date, the costs incurred by U.S. hospitals for the inpatient care of an unprecedented number of patients are unknown.

Previous studies used payment rates as an indicator of costs or relied on statistics from the early stages of the pandemic. Studies that considered Medicare underestimated the financial burden borne by patients due to out-of-pocket expenses and did not account for the costs incurred by hospitals and medical staff in providing necessary care.

The role of risk factors such as diabetes and obesity in increasing the risk of severe COVID-19 disease is well-documented. However, it remains unclear to what extent these comorbidities contributed to higher healthcare treatment costs.

Study Overview

The study documents the average costs borne by hospitals for the inpatient care of COVID-19 patients. The researchers also examined the heterogeneity of expenditures across pandemic waves and the sociodemographic characteristics of patients.

Anonymous inpatient-level data collected between March 1, 2020, and March 31, 2022, from over 800 hospitals, covering 97% of academic medical centers across the U.S., were analyzed.

Direct hospital costs for providing care were used to measure healthcare costs and were adjusted for different geographic areas with varying wage and labor cost indices. Costs were computed by Vizient, with individual billed amounts deemed directly proportional to patient care, such as equipment and personnel.

Subsequently, costs were adjusted based on hospital-specific cost-to-charge ratios calculated using data from the Centers for Medicare & Medicaid Services. All costs were calculated in constant U.S. dollars from January 2022.

Key Findings

With 1.3 million hospitalizations, the average inpatient care costs amounted to $11,275, translating to approximately $15 billion in direct hospital costs or utilization of medical resources. Between August 2020 and July 15, 2023, the U.S. Centers for Disease Control (CDC) reported 6.2 million hospital admissions.

An extrapolation of this number would result in total healthcare costs of $70 billion, excluding vaccinations, tests, outpatient care, or emergency room visits that did not result in hospitalization. Importantly, these are purely monetary costs, excluding other costs such as lost productive years, missed workdays, and increased financial burdens on families.

Certain chronic diseases were associated with significantly higher hospital costs. This could be due to severe illness; however, these conditions are not necessarily linked to longer hospital stays or the use of intensive care units (ICUs).

During the study period, inpatient treatment costs increased by 26%, compared to an average annual medical cost inflation of 2–5%. Costs for patients treated with extracorporeal membrane oxygenation (ECMO) or mechanical ventilation increased by approximately 35%.

Conclusions

During the COVID-19 crisis, medical costs increased, largely due to the intensified use of ECMO. The associated costs also rose as concerning virus variants emerged and care practices changed.

The main strengths of the current study are the large sample size and a representative national sample with hospital size heterogeneity. The main limitations of the study include measurement errors due to the use of administrative data that could lead to bias due to omitted deaths or comorbidities that may have occurred after discharge.

Although costs were derived from hospital charges, measurement errors could result from reflected patient or payer costs. It could also be argued that the hospitals included in the study were academic medical centers, not all hospitals, and therefore may not reflect the actual inpatient burden on the healthcare system.

Some patients may have been readmitted multiple times; therefore, the estimated costs per patient could be underestimated.

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