Healthcare costs and most used outpatient procedures for COVID-19 in Brazil over 2020

• Grant number: 25/04813-3
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: May 01, 2025
• End date: April 30, 2026
• Field of knowledge: Health Sciences - Physiotherapy and Occupational Therapy
• Principal Investigator: Gisela Cristiane Miyamoto
• Grantee: Melissa Sousa Galvão
• Host Institution: Faculdade de Medicina de Ribeirão Preto (FMRP). Universidade de São Paulo (USP). Ribeirão Preto , SP, Brazil
• Associated research grant: 23/02147-0 - Implementation of research in economic evaluation in health: cost-of-illness, utility measures and statistical methods, AP.JP

Abstract

In 2020, the coronavirus disease 19 (COVID-19) was a public health emergency worldwide. Patients with severe symptoms of COVID-19 often require long-term hospital care, and patients with mild and moderate symptoms may also require healthcare due to physical and pulmonary impairment. Cost-of-illness studies estimate the economic impact of different health conditions and can identify unnecessary healthcare expenditures, helping decision-makers on how to best allocate resources. Thus, the aim of this project will be to estimate healthcare costs and identify the most frequently used outpatient procedures for COVID-19 in Brazil over 2020. This will be a retrospective cohort cost-of-illness study using registry-based data. This study will be conducted from the perspective of the Unified Health System (Sistema Único de Saúde - SUS) using macro-costing and top-down approaches with a 12-month time horizon. Healthcare costs will be composed of inpatient care costs and outpatient care costs. Data on the amounts of resources used for COVID-19 in 2020 and the respective costs recorded in the Department of Informatics of the SUS (Departamento de Informática do SUS - DATASUS) will be extracted using the management and costing system of the Brazilian Ministry of Health. Inpatient care data will be derived from the Hospital Information System (SIH) and outpatient care data will be derived from the Outpatient Information System (SIA). Inpatient care costs will be extracted for the following categories: personnel services, in-hospital service, intensive care unit service, and companion's daily. Outpatient care costs will be extracted for the following categories: diagnostic procedures, therapeutic and minor surgical procedures, assistive devices, and supplementary services. Data will be extracted considering adults over 18 years-old, both sexes, and following the International Classification of Diseases 10th Revision (ICD-10) code related to COVID-19 (B34.2 - coronavirus infection, unspecified site). The TAB-WIN v.1.4.1 software will be used to extract and process data from the SIH and SIA. Data extraction will be conducted in an aggregated form using ICD-10 B34.2. In this study, it will not be possible to extract individual patient data. Therefore, the cost estimate per patient from SUS will not be performed. The epidemiological approach used in this study will be prevalence, in which the real impact of existing cases will be identified (total consumption of health resources in the SUS with a given health condition, COVID-19). After the extraction process, the data will be organized in spreadsheets in Microsoft Excel software. All monetary values will be extracted in Brazilian Real (R$) and later converted to 2020 International Dollar (I$) using the purchasing power parity approach. Healthcare costs (the sum of inpatient care and outpatient care costs) will be presented descriptively. Inpatient care costs and outpatient care costs will also be reported separately. The three most frequently used outpatient procedures in each category will be reported. The results of this study will show the economic impact of COVID-19 in Brazil over 2020. This cost-of-illness study will identify healthcare costs in inpatient and outpatient care for adults stratified by sex. Furthermore, the results of this study will identify the most frequently used outpatient procedures by patients from SUS with COVID-19 and consequently identify whether outpatient care costs are related to approaches recommended by clinical practice guidelines, especially with physical therapy.