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VOLUME 25 , ISSUE 10 ( October, 2021 ) > List of Articles

Original Article

Direct Medical Cost Analysis of Indian COVID-19 Patients Requiring Critical Care Admission

Kamini N Reddy, Jignesh Shah, Monidipa Chowdhury, Naveen Yerrapalem, Neeraja Pasalkar, Prashant P Jedge

Keywords : Cost, COVID-19, Intensive care unit

Citation Information : Reddy KN, Shah J, Chowdhury M, Yerrapalem N, Pasalkar N, Jedge PP. Direct Medical Cost Analysis of Indian COVID-19 Patients Requiring Critical Care Admission. Indian J Crit Care Med 2021; 25 (10):1120-1125.

DOI: 10.5005/jp-journals-10071-23991

License: CC BY-NC 4.0

Published Online: 21-06-2022

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Introduction: Intensive care unit (ICU) admission is required for approximately 25% of patients affected with coronavirus disease-19 (COVID-19) and imposes a high economic burden on patients in resource-limited settings. Method: We conducted a retrospective direct medical care cost analysis of COVID-19 patients requiring ICU admission after obtaining the Institutional Ethics Committee approval. Data were obtained from the records of patients admitted to the COVID-19 ICU of a tertiary care trust teaching hospital from June 2020 to December 2020. Direct costs were analyzed and correlated with various demographic variables and clinical outcomes. Results: A total of 176 patients were included (males—76%). The median direct medical cost for a median stay of 13 days was INR 202248.5 ($ 2742.91). Hospital drugs and disposables accounted for 20% of the total cost followed by bed charges (19%), equipment charges (17%), biosafety protective gear (15.5%), pathological and radiological tests (15%), clinical management (7.6%), and biomedical waste management (1.6%). Government schemes accounted for 79% of medical claims followed by directly paying patients (12.5%) and private insurance (8.5%). The cost was significantly higher in patients with diabetes mellitus and sepsis and in those requiring mechanical ventilation (MV) (p <0.05). Shorter lead time to hospital admission and lesser length of hospital stay were associated with significant lower direct cost. Conclusion: Direct medical care cost is substantial for COVID-19 patients requiring ICU admission. This cost is significantly associated with increased ICU and hospital stay, longer lead time to admission, diabetes mellitus, sepsis, and those who need high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), and MV.

  1. COVID live update: 171,934,651 cases and 3,575,699 deaths from the coronavirus–worldometer. Available from:
  2. Abate SM, Ahmed Ali S, Mantfardo B, Basu B. Rate of Intensive Care Unit admission and outcomes among patients with coronavirus: a systematic review and meta-analysis. PLoS One 2020;15(7):e0235653. DOI: 10.1371/journal.pone.0235653.
  3. Cleary SM, Wilkinson T, Tchuem CT, Docrat S, Solanki GC. Cost-effectiveness of intensive care for hospitalized COVID-19 patients: experience from South Africa. BMC Health Serv Res 2021;21(1):1–0. DOI: 10.1186/s12913-021-06081-4.
  4. Li XZ, Jin F, Zhang JG, Deng YF, Shu W, Qin JM, et al. Treatment of coronavirus disease 2019 in Shandong, China: a cost and affordability analysis. Infect Dis Poverty 2020;9(1):1–8. DOI: 10.1186/s40249-020-00689-0.
  5. Di Fusco M, Shea KM, Lin J, Nguyen JL, Angulo FJ, Benigno M, et al. Health outcomes and economic burden of hospitalized COVID-19 patients in the United States. J Med Econ 2021;24(1): 308–317. DOI: 10.1080/13696998.2021.1886109.
  6. Jayaram R, Ramakrishnan N. Cost of critical care in India. Indian J Crit Care Med 2008;12(2):55–61. DOI: 10.4103/0972-5229.42558.
  7. Government of India. Key indicators of social consumption in India: health. 2019. Available from:
  8. National Health Accounts|National Health Systems Resource Centre, MoHFW, Government of India. 2021. Available from:
  9. World Health Organization 2020. WHO R&D blueprint novel coronavirus COVID-19 therapeutic trial synopsis. 2020. Available from:
  10. Government of India, Ministry of Health & Family Welfare, Directorate General of Health Services. Revised Guidelines on Clinical Management of COVID–19. 2020. Available from:
  11. Gedik H. The cost analysis of inpatients with Covid-19. Acta Med 2020;36:3289. DOI: 10.19193/0393-6384_2020_6_520.
  12. Darab MG, Keshavarz K, Sadeghi E, Shahmohamadi J, Kavosi Z. The economic burden of coronavirus disease 2019 (COVID-19): evidence from Iran. BMC Health Serv Res 2021;21(1):1–7. DOI: 10.1186/s12913-021-06126-8.
  13. Khan AA, AlRuthia Y, Balkhi B, Alghadeer SM, Temsah MH, Althunayyan SM, et al. Survival and estimation of direct medical costs of hospitalized COVID-19 patients in the Kingdom of Saudi Arabia. Int J Environ Res Public Health 2020;17(20):7458. DOI: 10.3390/ijerph17207458.
  14. Bain SC, Czernichow S, Bøgelund M, Madsen ME, Yssing C, McMillan AC, et al. Costs of COVID-19 pandemic associated with diabetes in Europe: a health care cost model. Curr Med Res Opin 2021;37(1):27–36. DOI: 10.1080/03007995.2020.1862775.
  15. Vijay S, Bansal N, Rao BK, Veeraraghavan B, Rodrigues C, Wattal C, et al. Secondary infections in hospitalized COVID-19 patients: Indian experience. Infect Drug Resist 2021;14:1893–1903. DOI: 10.2147/IDR.S299774.
  16. Arefian H, Heublein S, Scherag A, Brunkhorst FM, Younis MZ, Moerer O, et al. Hospital-related cost of sepsis: a systematic review. J Infect 2017;74(2):107–117. DOI: 10.1016/j.jinf.2016.11.006.
  17. Rae M, Claxton G, Kurani N, McDermott D, Cox C. Potential costs of coronavirus treatment for people with employer coverage. Peterson Center on Healthcare and Kaiser Family Foundation; 2020.
  18. Mahatma Jyotirao Phule Jan Arogya Yojana|State Health Assurance Society, Government of Maharashtra. Available from:
  19. Boccuzzi SJ. Indirect health care costs. In: Cardiovascular health care economics. Totowa, NJ: Humana Press; 2003. p. 63–79. DOI: 10.1007/978-1-59259-398-9_5.
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