Cost Analysis of Hospitalization for COVID-19 in a Brazilian Public Teaching Hospital

Abstract

Objectives

This study aimed to measure the hospitalization costs for suspect or confirmation cases of COVID-19 and aggregate knowledge in the costing process for future research on related topics.

Methods

A cost calculation model was applied using absorption costing technique. Cost was allocated into 2 main groups: hospitalization and personnel. The cost analysis considers the hospital perspective. This is a retrospective study whose data were collected between April and September 2020, equivalent to the first wave of the disease in Brazil. This research uses data from Hospital Information System, Brazilian Unified Health System (SUS) Cost Calculation and Management System, and SUS Hospital Information System.

Results

The average total cost per hospitalization was US$11 260 (R$63 504) for patients suspect or confirmed by COVID-19, and considering only detectable cases, the value was US$17 178 (R$96 886). The profile of hospitalized patients was male (51%), with a mean age of 59 years, white ethnicity (64%), and average length of stay of 9 days.

Conclusions

The amount approved by SUS for remuneration of hospitalizations by COVID-19 proved to be insufficient to cover the calculated costs. The results of this study collaborate to measure the expenditure of hospital institutions with COVID-19 hospitalizations, contribute as a parameter for health managers to identify whether the values attributed to hospitalization by COVID-19 by the SUS are adequate to cover all costs involved, and provide lessons learned on costs to the public health system in the event of new pandemics.

Introduction

According to the World Health Organization, 80% of patients who contract the new coronavirus severe acute respiratory syndrome coronavirus 2 (COVID-19) have mild and uncomplicated symptoms, 15% progress to the hospitalization in infirmary beds, and 5% need an intensive care unit (ICU) for treatment.¹ Analysis conducted by the Federation of Hospitals, Clinics and Laboratories of the State of São Paulo in August 2020 indicates that, in the first 6 months of the spread of the disease in Brazil, the public health system made available new 8764 adult and pediatric ICU beds and private and charitable hospitals opened 11 061 beds for the treatment of patients with coronavirus.²

Opening new hospitalization beds requires investment in infrastructure, equipment, and operational costs. Considering the context of limited public resources, measuring costs becomes essential for conducting economic health assessments and supporting managers’ decision making with comparative data on costs and benefits.

This pandemic disease accounted for 25 million cases in Brazil until January 2022, being the third country with the highest number of cases and the second with the highest number of deaths.³ Due to this magnitude, the cost analysis is relevant because it contributes not only to measuring the financial expenditure but also as a parameter for Brazilian Unified Health System (SUS) managers to identify whether the value attributed to hospitalization for COVID-19 is adequate and sufficient to cover all costs involved.

On March 18, 2020, the Brazilian government defined the amount of R$800 (Brazilian currency—real), equivalent to US$141.84 for each COVID-19 ICU daily rate.⁴ Nevertheless, 1 week later, the amount was changed to R$1600 (US$283.68).⁵ This episode raises the question of the sufficiency of resources to stimulate the opening of new ICU beds, making it possible to pay for the entire treatment of the disease.

Thus, the present study aimed to measure the hospitalization cost for COVID-19 in a public teaching hospital from April to September 2020, the initial 6 months of infection in Brazil, equivalent to the first wave of the disease in the country. As specific objectives, this research identified the sociodemographic and hospital characteristics of hospitalized patients and compared the cost of hospitalization for COVID-19 with the remuneration provided by SUS.

Methods

A retrospective study with quantitative and qualitative analysis was developed. Data collection was performed with documental research and interview with the application of a semistructured questionnaire.

The study was developed in a public teaching hospital located in the state of Minas Gerais, Brazil. This is a midsize hospital⁶ with 137 inpatient beds. To provide hospitalizations for COVID-19, in March 2020 clinical infirmary was adapted to create an isolation area, in this research called “COVID-19 area” composed of 8 ICU beds and 7 infirmaries totaling 15 COVID-19 hospitalization beds.

Internal Regulation Nucleus (NIR) is the area where the admission of the patient in the hospital and the discharge checkout occur. Hospitalizations occur through 2 flows. The first refers to patients whose reason for admission is the suspicion or confirmation of COVID-19. In this case, the initial hospitalization occurs in the COVID-19 area, where reverse transcription polymerase chain reaction test will be conducted to confirm the infection. If the result is positive, the patient remains there, and if not, the patient is moved to an infirmary, where he will be treated according to a new diagnosis.

The second flow comprises cases in which admission occurs for a cause other than COVID-19 and during hospitalization there is a manifestation of symptoms of the disease. Thus, initially, the patient will be admitted to a standard infirmary and, in the presence of symptoms, will be sent to the COVID-19 area for tests.

Data Collection and Analysis

The cost analysis considers the hospital perspective. Retrospective data were collected for the period between April and September 2020 (6 months). Three data sources were consulted: Hospital Information System studied, SUS Cost Calculation and Management System (APURASUS), and SUS Hospital Information System (SIHSUS).

The Hospital Information System provided daily the frequency and length of stay of hospitalizations.

The National Cost Program of the Brazilian Ministry of Health developed the APURASUS. The hospital implemented this system in July 2018. It is updated monthly through the monitoring of contracts and invoices executed. This system adopts the absorption costing technique that organizes resource data in cost centers according to the hospital structure. The cost data obtained by APURASUS were composed of 3 cost centers: (1) COVID-19 area; (2) Examinations (clinical analysis, pathological anatomy, and imaging); and (3) NIR. The analyzed cost is presented in Figure 1 .

Figure 1.

COVID-19 hospitalization cost estimation model.

APURASUS indicates SUS Cost Calculation and Management System; HIS, Hospital Information System; ICU, intensive care unit; NIR, Internal Regulation Nucleus; SIHSUS, Brazilian Unified Health System Hospital Information System.

Due to the absence of individualized cost centers that segregated infirmary and ICU beds in the COVID-19 area, interviews with specialists were conducted using a semistructured questionnaire to distinguish the medical-hospital materials and medicines used in ICU beds and infirmary beds (Appendix 1 in Supplemental Materials found at https://doi.org/10.1016/j.vhri.2022.10.006). Seven interviews with healthcare professionals of medical-hospital supplies and pharmaceuticals sites, which included doctors, nurses, and pharmacists. The number of interviews was sufficient because it included specialists of all categories involved in the process.

For the other cost items, the separation between infirmary and ICU beds was performed based on apportionment criteria in the literature, such as square meters (m²), number of medical gas points, number of requisitions, patient per day, and number of employees.^{7 , 8}

The sociodemographic variables (age, sex, ethnicity), the results of the COVID-19 tests, and the outcome of hospitalizations were obtained by crossing the number of Hospital Inpatient Authorizations (AIH) with data from the SIHSUS.

To compare the calculated costs with the amount approved by the SUS for hospitalization of COVID-19, the data generated by the SIHSUS were consulted, where the invoiced amounts were presented by the hospital by the AIH obtained, which has the Sistema de Gerenciamento da Tabela de Procedimentos (SIGTAP)⁹ as a reference.

To conduct this comparative analysis, only the hospitalizations of confirmed cases are considered as the value approved by the SUS for the treatment of COVID-19 infection, given that the suspect cases with negative test results, despite adding to the hospital costs with hospitalization by COVID-19, according to the Ministry of Health cannot be billed with the coronavirus infection treatment code.¹⁰

Data were recorded, tabulated, and analyzed, and inference of the results was performed using Microsoft Office Excel 365® (Microsoft, Redmond, WA). The exchange rate used to convert the values obtained was R$5.64 for every US$1.00, referring to September 2020.

The ethics committee approved the research for Research with Human Beings of the hospital studied under protocol number 4,467,731.

Costing Method

The absorption costing method was adopted to calculate the hospitalization cost for suspect or confirmed COVID-19. According to Martins (2018), absorption costing is a technique where all production costs are allocated to products or services. Martins also highlights that absorption costing is methodologically accepted, in line with accounting principles.^{8 , 11}

For the development of the method, the first step is to classify the identified costs between direct and indirect. Direct costs are quickly allocated to their respective cost centers, and indirect costs are allocated using apportionment criteria. The calculation of costs begins with the definition of the apportionment criteria and the design of the location map, formed by the cost items (eg, salaries and electricity) and the productive and auxiliary cost centers. After completing the cost allocation, the balances from the auxiliary cost centers are transferred to the production cost centers and, finally, to the products and services.^{12 , 13}

The calculation of the total hospitalization costs comprises from admission to discharge of the patient. Thus, all costs were allocated to the costs of the NIR, COVID-19 area, and examinations and then aggregated into 2 groups: “hospitalization costs” and “personnel costs” according to the model presented in Figure 1. This cost calculation method was based on the model developed by Vieira et al¹⁴ adapted for clinical admissions.

The costs of the COVID-19 area, examinations, and NIR were prorated based on the proportion of daily hospitalizations in the COVID-19 infirmary and ICU, proportion of examinations requested for suspect or confirmed hospitalizations concerning the total, and proportion of patients admitted to the hospital for hospitalization in the COVID-19 area, respectively. Then, the average cost of the daily infirmary and COVID-19 ICU, the average cost of examinations per hospitalization, and an average cost of NIR per hospitalization were calculated. The “hospitalization cost” results from the sum of the average cost of these areas multiplied by the average length of stay of hospitalization. The “hospitalization cost per procedure” comes from the multiplication between the “cost of hospitalization” and the frequency of hospitalization procedures that generated suspicion or confirmation of COVID-19.

The “personnel cost” was estimated using the exact parameters of apportionment of the cost of hospitalization and is also obtained by absorption in the cost centers of the COVID-19 area, examinations, and NIR.

Results

Hospitalization Costs

The results of applying the COVID-19 hospitalization cost calculation model are presented in Table 1 . A total of 156 hospitalizations were performed including suspected and confirmed cases of COVID-19 in the studied period, 64 of them with a positive diagnosis for the new coronavirus (detectable cases) and 92 negatives (undetectable cases). They represented 1426 hospitalizations days, of which 477 are in the infirmary days and 949 in the ICU days. In the evaluated period, the occupancy rate was 30% for the infirmary beds and 73% for the ICU beds. Cost calculation did not consider this parameter.

Table 1.

COVID-19 hospitalization average costs.

Hospitalization procedure	Infirmary			ICU		Exam		NIR		Personnel		Total	VS	D
	a	b	c	d	e	f	g	h	i	j	k	l	m	n
	n	US$	(b/l)	US$	(d/l)	US$	(f/l)	US$	(h/l)	US$	(j/l)	(b + d + f + h + j)	US$	(m – l)
			%		%		%		%		%	US$		US$
Detectable cases (COVID-19 positive)	64	711	4.1	1530	8.9	293	1.7	12	0.1	14 631	85.2	17 178	2403	−14 776
Undetectable cases (COVID-19 negative)	92	313	4.4	509	7.1	293	4.1	12	0.2	6014	84.2	7142	846	−6297
Hospitalization (total cases)	156	477	4.2	928	8.2	293	2.6	12	0.1	9549	84.8	11 260	1484	−9775

D indicates difference between the amount approved by Brazilian Unified Health System and the average total cost; ICU, intensive care unit; NIR, Internal Regulation Nucleus; VS, average Hospital Inpatient Authorizations value approved by Brazilian Unified Health System.

Confirmed hospitalizations of COVID-19 were billed by procedure 03.03.01.022-3—treatment of infection by coronavirus—COVID-19, according to SIGTAP (2020). Hospitalizations of suspect cases whose subsequent diagnosis was negative to COVID-19 were reassessed to define the correct diagnosis of the patient and adequate billing.

Considering the total number of confirmed or suspect cases of coronavirus (156 hospitalizations), an average total hospitalization cost of R$63 504 (US$11 260) (column l) was computed.

Personnel cost is responsible for the most significant portion of the average total hospitalization cost, corresponding to 84.81% (R$53 858) (US$9549). Then there is a more significant share of the cost of ICU daily of R$5233 (US$927.84) (8.24%), infirmary daily of R$2688 (US$476.60) (4.23%), examinations of R$1655 (US$293.44) (2.61%), and NIR of R$70.00 (US$12.41) (0.11%).

The average total cost per hospitalization of detectable cases of COVID-19 (64 occurrences), according to column a, resulted in R$96 886 (US$17 178.37) (column l) with an average length of stay of 15 days, of which 5 days in the infirmary and 10 in the ICU. The most represented cost item was personnel, accounting for 85.17%. The second installment comprises the cost of hospitalization, subdivided into ICU daily in the amount of R$8630 (US$1530.14) (8.91%); infirmary daily, calculated at R$4011 (US$711.17) (4.14%); examinations, estimated at 1655 (US$293.44) (1.71%); and NIR, equivalent to R$70 (US$12.41) (0.07%).

Considering the other procedures (92 hospitalizations), which comprises suspects with the posterior negative test of COVID-19, the average total cost per hospitalization reached R$40 283 (US$7142.37) (column l), a difference of R$56 603 (US$10 035.99) (−58.42%) of the cost of treating positive cases of COVID-19.

The sensitivity analysis was performed with the cost items (infirmary, ICU, examinations, NIR, and personnel) that make up the total cost of hospitalization for detectable cases of COVID-19. Consolidated results are presented in Table 2 considering a total period of hospitalization of 15 days, composed of daily in the infirmary and in the ICU with variations in the number of days spent by nurses between 0 (completely hospitalized in the ICU) and 15 days (completely hospitalized in the infirmary). The results showed that the total cost of hospitalization is more sensitive to variations in the item cost of personnel. In this case, the variation of −15% in the cost of personnel affects the cost of hospitalization by −12.86%, whereas the variation of 15% affects the cost by 12.97%.

Table 2.

Sensitivity analysis on the cost of hospitalizations for COVID-19 (detectable).

Variables	Minimum, %	Maximum, %
Cost variation – infirmary	−1.79	2.18
Cost variation – ICU	−2.03	1.86
Cost variation – examinations	−0.34	0.45
Cost variation – NIR	−0.10	0.21
Cost variation – personnel	−12.86	12.97

ICU indicates intensive care unit; NIR, Internal Regulation Nucleus.

The results obtained for the average cost of hospitalization by type of hospitalization (infirmary, ICU, or mixed) without differentiating detectable from undetectable cases are presented in Table 3 . The highest cost per hospitalization occurred in mixed cases, with a cost of R$80 284 (US$14 234.75). This result refers, on average, to 6 days in the infirmary and 6 days in the ICU. Patients hospitalized exclusively in ICU beds incurred an average hospitalization cost of R$68 687 (US$12 178.54) for 10 days. It was observed the lowest cost in exclusive infirmary hospitalizations, where the average length of stay was 6 days, and the cost reached R$41 701 (US$7393.79).

Table 3.

Costs by type of hospitalization for suspect and confirmed cases.

Type of hospitalization	Number of admissions	Average length of hospital stay, days	Average length of stay in the ICU, days	Average cost of hospitalization including staff cost, US$
Infirmary	45	6	0	7394
ICU	76	0	10	12 179
Mixed (infirmary and ICU)	35	6	6	14 235

ICU indicates intensive care unit.

The highest hospitalization costs are those with ICU daily. Comparing the cost of exclusive hospitalization in infirmary beds with the cost of exclusive hospitalization in the ICU, the cost difference is 65%. In the COVID-19 scenario, this type of hospitalization is highly requested, including in the hospital in question; the number of hospitalizations in ICU beds was higher than hospitalizations in infirmary beds, which, in turn, reflects in higher cost to the institution.

Nevertheless, when analyzing the cost per day in exclusive infirmary and ICU beds, we have that the daily infirmary rate of R$6950 (US$1232.30) overlaps the cost of the ICU bed rate of R$6868 (US$1217.85). This is justified by the low occupancy rate of the infirmary beds (30%) in relation to the expenses evidenced, thus increasing the daily rate of these beds compared with the daily rate of the ICU, which had an occupancy rate of 73%.

Sociodemographic and Hospital Variables

The variables that characterize hospital admissions are presented in Table 4 . Considering the total number of hospitalizations, the age range of patients ranged between 15 and 98 years, with a mean and median value of 59 years and SD of 17 years. The frequency of individuals by age intervals to all samples is presented in Figure 2 . The mean and median values for detectable cases were 61 years, with SD of 16 years. This result characterizes the sample population as most adults and older people.

Table 4.

Sociodemographic and hospital variables.

Variables	Total	Detectable (COVID-19 positive)	Undetectable (COVID-19 negative)
	N = 156	n = 64	n = 92
Age, years, mean/median/SD	59/59/17	61/61/16	58/59/18
Male	51%	61%	45%
White ethnicity	64%	67%	62%
Average length of stay, days	9	15	5
ICU percentile days	71%	75%	68%
Detected	41%	-	-
Mortality	17%	22%	14%

ICU indicates intensive care unit.

Figure 2.

Age distribution histogram.

The sex representation of the sample proved to be balanced, with 51% of males. For the purposes of the analysis of this study about ethnicity, white and yellow was considered white, which represented a proportion of 64% of patients and 36% of nonwhite ethnicity (black, indigenous, and brown).

The mean length of stay for suspect or confirmed COVID-19 resulted in 9 days (SD = 9), with 6 days of ICU beds and 3 days of infirmary. Of the total number of hospitalizations, 71% required at least one day in ICU beds, 41% of those admitted tested positive for COVID-19 and 17% of the patients died.

Considering the average length of stay, patients detectable by COVID-19 were hospitalized by triple the time for undetectable patients.

Comparison of the Average Hospitalization Cost With the Value From SUS

According to the SIGTAP, the reference value to billing COVID-19 hospitalization consists of R$1500 (US$265.95) and each day of COVID-19 accredited ICU beds sums R$1600 (US$283.68) to hospitalization value.⁹

Thus, considering exclusively confirmed cases of COVID-19 (64 hospitalizations), the total cost calculated was R$6200.69 (US$1099.41) (Table 1, column l × column a), with an average hospitalization cost of R$96 886 (US$17 178.36) (Table 1, column l). The total amount approved by the SUS in AIH was R$867.31 (US$153.77) (Table 1, column m × column a), with an average value per hospitalization of R$13 552 (US$2402.84) (Table 1, column m). Comparing these data results in a total deficit of −R$5 333 387 (R$867 307-R$6 200 694) (−US$945 636) (US$153.77-US$1099.41) for the hospital and −R$83 334 (−US$14 776) (Table 1, column n) per hospitalization.

From the perspective that hospitalizations with a negative diagnosis for coronavirus also incur costs of treating COVID-19 by the hospital and prevent other patients from being admitted to these beds, there is a total cost calculated for suspect cases and confirmed cases of COVID-19 (156 hospitalizations) of R$9 906 697 (US$1 756 506) (Table 1, column l × column a). If we also consider the amount approved by the SUS for suspect cases of COVID-19 billed with a code from another procedure after clinical reanalysis, the amount received from the SUS is R$1 306 054 (US$231 570) (Table 1, column m × column A), which makes the comparison with the average total cost of hospitalizations a deficit of −R$8 600 643 (−US$1 524 937).

Despite the deficit presented, the accreditation of the hospital of 8 ICU beds for the exclusive treatment of COVID-19 from June 2020,¹⁵ comprising 4 months of the researched period, resulted in a fixed daily remuneration of R$1600 (US$283.68) per accredited ICU bed, totaling the amount received of R$1 536 000 (US$27 234.04) referring to the 8 ICU beds available for 120 days. Considering only the fixed amount paid for the ICU daily, it is still not possible to cover the costs with the 64 confirmed hospitalizations of coronavirus (R$6 200 694) (US$1 099 413).

Discussion

Restricting the analysis of the database to the 64 confirmed hospitalizations, one ICU daily rate costs an average of R$6860.38 (US$1216.38). Comparing the cost of the ICU daily rate calculated with the amount initially planned by the SUS of R$800.00⁴ (US$141.84) to cover the ICU daily rate for the treatment of COVID-19, it is observed that the amount paid would result in a deficit for the institution of −R$6060.38 (−US$1074.54).

Not even the change in the daily ICU rate to R$1600.00⁵ (US$283.69) was sufficient to cover the deficit generated by comparing the cost of the ICU daily rate calculated with the SUS reimbursement amount of −R$5260.38 (R$1600.00-R$6860.38) (−US$932.69) (US$283.69-US$1216.38). The financed amount represents only 23% of the calculated cost.

In Brazil, the company Planisa, which specialized in health management, developed a study with 7 Brazilian hospitals of reference for the care of COVID-19 to measure the cost of hospitalization for coronavirus in infirmary and ICU beds using the absorption costing method.¹⁶

Each daily in the infirmary costs R$1139 (US$201.95) and R$2234 (US$396.10) in an ICU bed. Although the present study uses the same costing technique as the research developed by Planisa, the values obtained proved to be higher, R$6151.81 (US$1090.75) each day in the infirmary and R$6860.38 (US$1216.37) in the ICU. One of the possible explanations for this discrepancy is the volume of resources spent on labor, which in the survey represents 85.17% of the calculated cost. A second point to be noted concerns the fixed working hours of public servants, regardless of the volume of care.

The Unicamp from Campinas and Hospital das Clínicas from São Paulo (HCFMUSP) conducted studies on the hospitalization cost for COVID-19 in institutions providing exclusive assistance to SUS users. Unicamp calculated the cost of R$2500 (US$443.26) to R$3000 (US$531.91) per day in ICU.¹⁷

The HCFMUSP developed a study in which it analyzed 3254 patients admitted to the hospital from March to June 2020 and observed the average hospitalization cost of R$68 100 (US$12 074.47) for less complex cases and an average expense of R$109 000 (US$19 326.24) for hospitalization in ICU beds.¹⁸

The HCFMUSP is similar to the hospital studied because both are teaching hospitals, so that the values found in this study are the ones that most resemble the present work, where the value of hospitalization for COVID-19 in the infirmary was R$57 001 (US$10 106.56) and the average value of hospitalization in the ICU reaches R$104 519 (US$18 531.74). These results are in line with the literature, which finds that the costs of teaching hospitals are higher than those that do not include this function.^{19 , 20}

Comparing the current study with results of some international studies of hospitalization costs for the COVID-19, available in the Web of Science, Scopus, and Google Scholar databases, it is observed that most of the articles analyzed had a hospitalization cost lower than that obtained in this study (US$17 178).

The study by Bain et al²¹ presented cost of US$20 540, higher than that found in this study. The author analyzed the hospitalization cost for COVID-19 in Europe in diabetic patients and those without diabetes (the cost used in this study refers to the hospitalization of patients without diabetes). Their study retrieved information from publicly available cost data from Denmark, France, Spain, and United Kingdom, and for the remaining 28 countries, costs were estimated using the Eurostat cost index.

The hospitalization cost that is closest to this study was that realized in Saudi Arabia by Khan et al²² (US$16 283—average of the costs of severe and critical cases), which aimed to assess the survival of hospitalized patients with coronavirus in distinct groups and used the microcosting technique to estimate the direct medical costs associated with hospitalization.

In contrast, the cost of hospitalization that was farthest from that measured in this study was that of Lee et al,²³ with a cost of US$2192, which represented only 13% of the cost calculated in this research. The cost of hospitalization was calculated from data from the National Health Insurance System of Korea and refers to the average length of stay of 10.38 days. This study analyzed only pediatric hospitalizations, which may contribute to the lower cost observed.

The research of Jin et al²⁴ analyzed the economic cost of COVID-19 in China and in 31 administrative regions. The calculated cost of this hospitalization was US$3193. This study was conducted using a bottom-up technique to measure costs and stands out for presenting, in addition to medical costs, the social costs associated with COVID-19. The social and health costs estimated by the study totaled US$0.62 billion and US$383.02 billion, respectively.

In addition to the studies mentioned earlier, 2 other studies developed in the United States found costs for hospitalizations for COVID-19 with higher values (US$14 366²⁵ and US$12 046²⁶) than eastern countries, a study in Indonesia found the cost of this hospitalization at US$5347,²⁷ and another study in Iran estimated the cost at US$3755.²⁸ All these had costs lower than the cost determined in this research.

In general, it was observed that the reviewed international studies mentioned earlier were developed with different objectives. Regarding the method, a great variation was observed in the methodology applied, and in some studies, the costing technique used was not specified. Most of the studies identified refer to Asian countries, which refer mainly to the continent and country of origin of the disease. The highest costs belonged to the United States and European countries, and the lowest costs were present in Asian countries, as observed in China, Korea, Iran, and Indonesia.

Conclusion

The main objective of this study was to measure the cost of hospitalization for COVID-19 in a public teaching hospital. Therefore, an average total cost per hospitalization of R$63 504 (US$11 259.57) was obtained for patients suspect or confirmed by COVID-19. Considering only detectable cases, there is an average total cost per hospitalization of R$96 886 (US$17 178.37). The amount approved by the SUS covered 14% of the cost, resulting on a deficit of −R$83 334 (US$14 776) per hospitalization. Therefore, this amount was sufficient to cover infirmary, ICU, examinations, and NIR costs, not covering personnel costs, which are the main ones.

The cost results provide important information for future economic assessments of COVID-19 and can be used as a parameter for SUS managers to identify whether the value attributed to hospitalization for COVID-19 in SIGTAP is adequate and sufficient to cover all the costs involved.

This research has the limitations of conducting the cost study in a single hospital, difficulty in formatting cost centers, the number of hospitalizations, and the period of 6 months in which they were evaluated. Such limitations may make it difficult to generalize the results, so the following suggestions are proposed for future investigations: apply the method used in referral hospitals to combat the coronavirus, analyze the costs of COVID-19 over a more extended period of data, adjustments in cost centers be made preliminarily in the institutions to better determine costs, and investigate how Brazilian legislation can affect health financing, considering that real expenses have the potential to exceed the reimbursement provided by the SUS.

Article and Author Information

Author Contributions:Concept and design: Ferreira de Sousa, Vieira

Acquisition of data: Ferreira de Sousa

Analysis and interpretation of data: Ferreira de Sousa, Vieira, Reis

Drafting of the manuscript: Ferreira de Sousa, Vieira, Reis

Critical revision of the paper for important intellectual content: Ferreira de Sousa, Vieira, Reis

Statistical analysis: Ferreira de Sousa

Administrative, technical, or logisticsupport: Vieira

Supervision: Vieira, Reis

Conflict of Interest Disclosures: The authors reported no conflicts of interest.

Funding/Support: The authors received no financial support for this research.