OBJECTIVES: Estimate the direct medical costs for acute COVID-19 treatment in the adult population within Guatemala's National Healthcare System (NHS).

METHODS: A standardized questionnaire was administered to Guatemalan clinical experts 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 using data from the Guatemalan Social Security Institute, Ministry of Public Finance, and other public sources. Costs in local currency were converted to 2023 USD.

RESULTS: Across all age groups, outpatient care costs averaged USD$486.6 (unvaccinated, low-risk) to USD$500.8 (unvaccinated, high-risk) and USD$510.2 (vaccinated, regardless of risk). According to the clinical experts, despite receiving the same medical care, vaccinated patients had potentially higher educational level and therefore had higher number of medical consultations than unvaccinated patients. General ward costs (all age groups) displayed minimal variation, averaging around USD$8,738.8 to USD$8,765.1 in high-risk and USD$8,740.4 to USD$8,745.0 in low-risk patients (vaccinated vs unvaccinated, respectively). ICU care costs were significantly higher, ranging from USD$19,353.5 and USD$16,809.8 for high-risk (unvaccinated and vaccinated, respectively); while low risk was USD$19,317.7 and USD$16,369.5 (unvaccinated and vaccinated, respectively). The cost of care was highest for unvaccinated ICU patients ≥75 years old (high-risk: USD$26,142.3; low-risk: USD$26,097.7). Use of mechanical ventilation in the ICU increases costs by USD$13,897.7 across all age groups. In the ICU setting, older adults (≥65 years) had higher HCRU/costs compared to younger patients; nonetheless, vaccinated patients ≥65 years accrued lower costs than the unvaccinated.

CONCLUSIONS: In Guatemala, low vaccination rates and excess morality were major challenges during the pandemic. COVID-19 remains a major economic burden for Guatemala's NHS, even in an endemic situation, especially for older unvaccinated adults and severe cases.