OBJECTIVES : To investigate the costs related to COVID-19 patients’ hospital management (from positivity confirmation to discharge, including rehabilitation activities), defining overall resources’ absorption with regard to both the COVID-19 per day and the COVID-19 clinical pathway costs, based on the patients’ clinical condition.

METHODS : A time-driven activity-based costing approach was implemented to define the costs related to the hospital management of COVID-19 positive patients, according to real-word data derived from six Italian Hospitals, in 2020. The average per-day cost and the average most frequent clinical pathways (considering the internal transfers between wards, based on the patient’s clinical improvement or deterioration), were valorised according to: 1) low-complexity hospitalizations; 2) medium-complexity hospitalizations, with presence of hospital beds equipped with C-PAP or non-invasive ventilation; 3) high-complexity hospitalizations.

RESULTS : The higher the complexity of care, the higher the hospitalization cost per day (low-complexity=€475.86; medium-complexity=€700.20; high-complexity=€1,401.65). Focusing on the entire clinical pathway (ER access, ward transfer, and rehabilitation): i) 29% spent 18.6 days between a medium and a low-complexity hospitalization (€10,778); ii) 16% spent 17.7 days between a low and a medium-complexity hospitalization (€13,902); iii) 12% spent 22.6 days between a high and a medium-complexity hospitalization (€25,817); iv) 8% spent 23.4 days between a medium and a high-complexity hospitalization (€32,141) and v) 5% spent 18.4 days between a low and a high-complexity hospitalization (€23,431). 30% of patients did not experience any ward’s transfer: 17% spent 10.2 within a medium-complexity hospitalization, 9% spent 13 days within a low-complexity hospitalization and 4% spent 11 days within a high-complexity hospitalization, requiring on average €10,113, €6,198 and €21,346 respectively for their management.

CONCLUSIONS : The study reported the economic evaluation of COVID-19 pandemic in Italy, providing real-world data for an adequate healthcare resources’ allocation, being useful for the further development of proper reimbursement tariffs devoted to COVID-19 positive hospitalized patients.