Demographic and hospitalization findings of the study population
9711 hospitalized COVID-19 patients were identified from 20 March 2020 to 20 March 2021 using HIS database. Table 1 presents the demographic, and hospitalization characteristics of studied cases.
The mean age of the hospitalized COVID-19 patients was 49.7±18.50 years. 2.62 % of the patients were under 15 years old, 75% were 15–65 years old and 22.3% were 65 years or higher. On average, the length of stay (LOS) per patient was 4.71 days and the same indicator among the ICU patients was 9.88 days.
Table 1: Demographic characteristics of patients studied in 2020 (N = 9711)
Variables
|
All patients
|
ICU patients
|
Dead patients
|
Count
|
%
|
count
|
%
|
Count
|
%
|
Gender
|
Female
|
4430
|
46
|
338
|
45
|
295
|
41
|
Male
|
5281
|
54
|
420
|
55
|
422
|
59
|
Insurance status
|
Yes
|
9180
|
95
|
734
|
97
|
690
|
96
|
No
|
531
|
5
|
24
|
3
|
27
|
4
|
residency
|
Rural
|
1728
|
18
|
152
|
20
|
153
|
21
|
Urban
|
7983
|
82
|
606
|
80
|
564
|
79
|
Discharge status
|
Death
|
717
|
7
|
474
|
63
|
717
|
100
|
Recovery
|
8994
|
93
|
283
|
37
|
0
|
0
|
|
Mean
|
SD
|
mean
|
SD
|
Mean
|
SD
|
Age
|
49.74
|
18.50
|
58.24
|
20.66
|
64.16
|
16.82
|
Los
|
4.71
|
5.35
|
9.88
|
8.88
|
9.53
|
9.53
|
54% of the hospitalized COVID-19 cases were male and approximately the same percentage of ICU COVID-19 patients were male as such almost three-fifths of dead COVID-19 patients were male. Of hospitalized cases, 95% were insured and 82% of whom were residents of urban areas. Overall, 7% of hospitalized COVID-19 patients died while the death rate of ICU patients was 63%.
direct medical costs
given the results, the total direct cost was calculated to be 439,774,265,491 Rials ($ 27,893,838) and in turn, the average direct cost was 45,286,198 Rials ($ 2872) per patient (table 2,3).
findings also showed that the largest share of direct costs belonged to the in-patient beds cost and drugs with 36.44% and 30.80% equivalent to $10,164,189 and & 8,590,578r respectively.
fallowing that, ICU costs accounted for 26.88% of total direct costs. all in all, the three major cost groups mentioned above constituted approximately 95 % of total direct costs (table2).
Table 2: major components of direct costs of hospitalized COVID-19 patients
Cost components
|
Total
|
Mean cost(Rial)
|
%
|
Hospitalization
|
160,248,610,431
|
36.44
|
Drugs
|
135,439,061,633
|
30.80
|
ICU
|
118,212,523,672
|
26.88
|
Others
|
25,874,069,755
|
5.88
|
Total
|
439,774,265,491
|
100
|
Table 3: Average direct and indirect cost per patient (Rial).
|
Direct cost
|
Indirect cost
|
Lost income
|
Premature death
|
Hospitalization
|
Recovery at home
|
Cost per patient
|
45,286,198
|
2,865,600
|
8,915,200
|
2,612,176,739
|
Total
|
439,774,265,491
|
20,884,492,800
|
62,058,707,200
|
854,181,793,653
|
Economic burden
|
1,376,899,259,144
|
Indirect cost
Lost productivity due to hospitalization
To estimate indirect costs of hospitalized patients, the average length of stay (LOS) of 15–65-year-old patients (4.5 days) was multiplied by the minimum daily wage (636,800). Consequently, indirect cost per patient was estimated to be 2,865,600 Rials equivalent to $182
Lost productivity due to Convalescence period
Production loss owing to the recovery period at home was estimated through multiplying with average days of Convalescence period (14 days) in the minimum daily wage of recovered patients 15-65 years old and it was calculated 8,915,200 Rials ($ 566).
Lost productivity due to premature death
To calculate average years of lost life (YLL), the average age of dead patients (52 years) was subtracted from the maximum productivity age (65 years) and as a result, YLL calculated 13 years. given the fact that the salary of dead patients was not available, the minimum salary determined by the Iran Labour Organization (ILO) in 2020 was utilized. It was calculated 244,251,240 per year ($ 15,492) for a dead patient. Finally using the previously mentioned formula in methodology, lost productivity for all dead patients in productive age (327 patients) was estimated as follows.
p=2,612,176,739*327=854,181,793,653Rials ($ 54,178,726).
Economic burden
Economic burden was estimated according to the equation mentioned in the methodology. As a result, Economic burden = (direct cost per patient* the number of hospitalized COVID-19 patients) + (the number of patients 15 to 65* average indirect cost due to absence at work) + (the number of dead patients 15 to 65 * average indirect cost due to premature death).
C= (45,286,198*9711) + (2,865,600*7288) + (8,915,200*6961) + (2,612,176,739*327) =1,376,899,259,144 Rials ($ 87,333,455).
In line with the proportion of Bushehr to Iran population (1.64%), the Economic burden imposed by COVID 19 on the country during the studied period would be 83,957,271,899,024 Rials ($ 5,325,210,700).
Sensitivity analysis
Since the estimated indirect burden is sensitive to the average daily wage as well as the number of employed people, a sensitivity analysis was performed in the (-20, +20) range to increase the robustness of the results. With these explanation, economic burden of Bushehr province would be ($ 74,702,946- $ 99,221,156) and consequently Iran’s economic burden to be estimated ($ 4,555,057,621- $ 6,046,235,487) within the study period.