Evaluation of the Costs and Outcomes of COVID-19 Therapeutic Protocols in Critically Ill Patients in Alzahra Hospital, Isfahan, Iran
-
Majid Davari
,
Sarah Mousavi
,
Mohammad Reza Maracy
,
Elahe Khorasani
,
Masih Zamani
,
Mohammadreza Amirsadri
Abstract
Background: During the COVID-19 pandemic, different drug protocols were used to treat and manage patients. Considering the diversity in these protocols and the high costs associated with the disease, we aimed to evaluate the costs and effects of the most common therapeutic protocols among critically ill COVID-19 patients.
Methods: In this retrospective cross-sectional study, a total of 235 critically ill COVID-19 patients were randomly selected from those hospitalized in the Intensive Care Units of Alzahra Hospital, Isfahan, Iran, between July and December 2020. The study assessed demographic data, outcomes (mortality rate), severity of the disease (SOFA score), and average direct costs of each therapeutic regimen. Statistical analysis included Cox-Regression analysis and Kaplan-Meier survival curve.
Results: We identified 21 therapeutic protocols based on prescribed medications, with six protocols being the most commonly used. The protocol containing dexamethasone + methylprednisolone showed the highest survival probability (0.79) with a median length of hospital stay of 17 days. Cost evaluation revealed that the dexamethasone protocol had the lowest average cost per patient, while the dexamethasone + methylprednisolone + remdesivir protocol had the highest. Hoteling costs accounted for 45% of the total costs, followed by medication costs (25%).
Conclusion: The dexamethasone + methylprednisolone therapeutic regimen demonstrated the highest effectiveness in terms of survival probability and was also associated with the lowest average cost per patient.
2. Tuite AR, Bogoch II, Sherbo R, Watts A, Fisman D, Khan K. Estimation of coronavirus disease 2019 (COVID-19) burden and potential for international dissemination of infection from Iran. Ann Intern Med. 2020;172(10):699-701.
3. Li L, Li R, Wu Z, et al. Therapeutic strategies for critically ill patients with COVID-19. Ann Intensive Care. 2020;10(1):45.
4. Arentz M, Yim E, Klaff L, et al. Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State. Jama. 2020;323(16):1612-4.
5. Bhatraju PK, Ghassemieh BJ, Nichols M, et al. Covid-19 in Critically Ill Patients in the Seattle Region - Case Series. N Engl J Med. 2020;382(21):2012-22.
6. Behboodikhah H, Shorafa E, Karimzadeh I, et al. Evaluation of the Costs and Outcomes of COVID-19 Therapeutic Regimens in Hospitalized Patients in Shiraz. Iran J Sci Technol Trans A Sci. 2022;46(5):1339-47.
7. Chibber P, Haq SA, Ahmed I, Andrabi NI, Singh G. Eur J Pharmacol. 2020;883:173372.
8. Tobaiqy M, Qashqary M, Al-Dahery S, et al. Therapeutic management of patients with COVID-19: a systematic review. Infect Prev Pract. 2020;2(3):100061.
9. Donner A, Klar N. Design and Analysis of Cluster Randomization Trials in Health Research. Arnold: London; 2000.
10. Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22(7):707-10.
11. Vincent JL, de Mendonça A, Cantraine F, et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine. Crit Care Med. 1998;26(11):1793-800.
12. Abd ElHafeez S, D'Arrigo G, Leonardis D, Fusaro M, Tripepi G, Roumeliotis S. Methods to Analyze Time-to-Event Data: The Cox Regression Analysis. Oxid Med Cell Longev. 2021;2021:1302811.
13. Goel MK, Khanna P, Kishore J. Understanding survival analysis: Kaplan-Meier estimate. Int J Ayurveda Res. 2010;1(4):274-8.
14. Bonanad C, García-Blas S, Tarazona-Santabalbina F, et al. The Effect of Age on Mortality in Patients With COVID-19: A Meta-Analysis With 611,583 Subjects. J Am Med Dir Assoc. 2020;21(7):915-8.
15. Mukherjee S, Pahan K. Is COVID-19 Gender-sensitive? J Neuroimmune Pharmacol. 2021;16(1):38-47.
16. Biswas M, Rahaman S, Biswas TK, Haque Z, Ibrahim B. Association of Sex, Age, and Comorbidities with Mortality in COVID-19 Patients: A Systematic Review and Meta-Analysis. Intervirology. 2020:1-12.
17. Ghaffari Darab M, Keshavarz K, Sadeghi E, Shahmohamadi J, Kavosi Z. The economic burden of coronavirus disease 2019 (COVID-19): evidence from Iran. BMC Health Serv Res. 2021;21(1):132.
18. Li XZ, Jin F, Zhang JG, et al. Treatment of coronavirus disease 2019 in Shandong, China: a cost and affordability analysis. Infect Dis Poverty. 2020;9:78.
19. Rocha JLL, Riediger I, Gasparetto J, Tuon FF. COVID-19 in real world: Survival and medical costs of hospitalized patients in Brazil´s first wave. Braz J Infect Dis. 2023;27(4):102778.
| Files | ||
| Issue | Vol 12, No 4 (Autumn 2024) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jpc.v12i4.17453 | |
| Keywords | ||
| Covid-19 Cost Evaluation Intensive Care Unit Therapeutic Regimen | ||
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