Medical Costs of Adults With COVID-19 in Costa Rica 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 national public healthcare system (NPHS) perspective of Costa Rica (Caja Costarricense de Seguro Social [CCSS]).

METHODS: A standardized questionnaire was administered to Costa Rican clinical experts to estimate the Healthcare Resource Utilization (HCRU) for adult patients with 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 the latest CCSS´s Model Tariff and other public official records. Costs in local currency were converted to 2023 USD.

RESULTS: Across all age groups, the average cost of outpatient care in high-risk patients was USD$2,811.7 and USD$2,752.0 (unvaccinated and vaccinated, respectively); for low–risk patients the average cost was USD$2,716.3 (unvaccinated) and USD$2,707.3 (vaccinated). In the general ward, the average cost (all age groups) in the high-risk patients was USD$9,051.3 for the unvaccinated and USD$8,409.8 for vaccinated patients, in contrast with USD$8,051.7 (unvaccinated) and USD$7,523.6 (vaccinated) in the low-risk group. In the ICU, the costs increased drastically, being on average USD$40,906.5 and USD$32,709.7 for high-and low-risk patients, respectively, regardless of the vaccination status. The main cost driver in both the ICU and general ward setting was the hospitalization cost (inpatient-stay). Use of mechanical ventilation in the ICU increases costs by USD$15,430.3 more for any age group.

CONCLUSIONS: COVID-19 still causes significant economic costs to CR´s NPHS, even as it becomes endemic. Overall, patients ≥30 years old had higher HCRU/healthcare costs in all cases (ICU and general ward), nonetheless, compared to vaccinated patients, unvaccinated high-and low-risk patients in the general ward had greater consumption of health resources, therefore, they incur higher direct care costs.