Evaluation of the Costs and Outcomes of COVID-19 Therapeutic Protocols in Critically Ill Patients in Alzahra Hospital, Isfahan, Iran

Majid Davari; Sara Mousavi; Mohammad Reza Maracy; Elahe Khorasani; Masih Zamani; Mohammadreza Amirsadri

doi:10.18502/jpc.v12i4.17453

Majid Davari Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Pharmaceutical Management and Economics Research Center, The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences
Sara Mousavi Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.
Mohammad Reza Maracy Department of Epidemiology and Biostatistics, School of Health, Environment Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences
Elahe Khorasani Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
Masih Zamani Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.
Mohammadreza Amirsadri Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.

DOI: https://doi.org/10.18502/jpc.v12i4.17453

Keywords: Covid-19, cost evaluation, intensive care unit, therapeutic regimen

Abstract

Background: During the COVID-19 pandemic, different drug protocols were used to treat and manage patients. Considering the diversity in these protocols and the high costs associated with the disease, we aimed to evaluate the costs and effects of the most common therapeutic protocols among critically ill COVID-19 patients.

Methods: In this retrospective cross-sectional study, a total of 235 critically ill COVID-19 patients were randomly selected from those hospitalized in the Intensive Care Units of Alzahra Hospital, Isfahan, Iran, between July and December 2020. The study assessed demographic data, outcomes (mortality rate), severity of the disease (SOFA score), and average direct costs of each therapeutic regimen. Statistical analysis included Cox-Regression analysis and Kaplan-Meier survival curve.

Results: We identified 21 therapeutic protocols based on prescribed medications, with six protocols being the most commonly used. The protocol containing dexamethasone + methylprednisolone showed the highest survival probability (0.79) with a median length of hospital stay of 17 days. Cost evaluation revealed that the dexamethasone protocol had the lowest average cost per patient, while the dexamethasone + methylprednisolone + remdesivir protocol had the highest. Hoteling costs accounted for 45% of the total costs, followed by medication costs (25%).

Conclusion: The dexamethasone + methylprednisolone therapeutic regimen demonstrated the highest effectiveness in terms of survival probability and was also associated with the lowest average cost per patient.