Medical Costs of Adults With COVID-19 in Dominican Republic (DR) During the Endemic Phase: A Micro-Costing Study

OBJECTIVES: Estimate the direct medical costs (per patient) related to the acute management of adult patients with COVID-19, from the perspective of DR´s national healthcare system (NHS).

METHODS: A standardized questionnaire was administered to clinical experts from DR to estimate the Healthcare Resource Utilization (HCRU) for adult patients with acute COVID-19. The questionnaire considered factors like age group, vaccination status, and risk of severe outcomes. A base case approach identified resource needs for outpatient, general ward, and ICU settings. Unit costs were assigned to these resources based on data from the National Health Service, Health and Labor Risks Superintendence, public tariffs for health services and the program of essential medicines. Costs in local currency were converted to 2023 USD.

RESULTS: The average cost of outpatient care (across all ages) was USD$1,644.2 and USD$1,571.2 in high-risk, and USD$1,535.7 and USD$1,477.5 in low-risk, for unvaccinated and vaccinated patients, respectively. In the general ward (all age groups), the high-risk group cost an average of USD$2450.2(unvaccinated) and USD$2425.8(vaccinated), with higher costs for those over 50 years old; for low-risk patients the average cost was USD$1,938.4 (unvaccinated) and USD$1,937.0 (vaccinated). In the ICU, the costs increased drastically, being on average USD$14,406.5 and USD$14,366.3 for high-risk; while low risk was USD$14,137.7 and USD$14,143.7 in unvaccinated and vaccinated, respectively. The main cost drivers that influenced the total cost of ICU and general ward were medications, laboratory tests and doctor/HCP visits (except for high-risk patients<50 years in general ward who had higher hospitalization costs than doctor/HCP visits). Use of mechanical ventilation in the ICU increases costs by USD$14,846.8 for any age group.

CONCLUSIONS: COVID-19 still causes significant economic costs to DR´s NHS, even as it becomes endemic. Overall, unvaccinated high-risk patients used more healthcare resources and incurred in higher expenses; furthermore, high-risk vs. low-risk patients had higher HRCU across all age groups.