Evaluation of the Costs and Outcomes of COVID-19 Therapeutic Regimens in Hospitalized Patients in Shiraz

Hooman Behboodikhah; Eslam Shorafa; Iman Karimzadeh; Mohsen Moghadami; Javad Shahmohammadi; Mohsen Bayati; Khosro Keshavarz; Manica Negahdaripour

doi:10.1007/s40995-022-01351-0

Evaluation of the Costs and Outcomes of COVID-19 Therapeutic Regimens in Hospitalized Patients in Shiraz

Iran J Sci Technol Trans A Sci. 2022;46(5):1339-1347. doi: 10.1007/s40995-022-01351-0. Epub 2022 Sep 15.

Authors

Hooman Behboodikhah^{1

2}, Eslam Shorafa³, Iman Karimzadeh⁴, Mohsen Moghadami⁵, Javad Shahmohammadi⁶, Mohsen Bayati⁷, Khosro Keshavarz^{7

8}, Manica Negahdaripour^{1

2}

Affiliations

¹ Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
² Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, P.O. Box 71345-1583, Shiraz, Iran.
³ Division of Intensive Care Unit, Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
⁴ Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.
⁵ Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
⁶ Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
⁷ Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
⁸ Emergency Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Abstract

COVID-19 patients in critical conditions are hospitalized and treated with various protocols including antiviral drugs, which have been updated repeatedly. This study was aimed to analyze the demographics, costs, and outcomes of drug regimens in COVID-19 patients hospitalized in "Ali Asghar" hospital, affiliated with Shiraz University of Medical Sciences, from March 2019 to December 2020 as a retrospective study, approved by the ethics committee of Shiraz University of Medical Sciences (IR.SUMS.REC.1399.1003) on Dec. 28, 2020. Using hospital information system (HIS) data, 2174 patients receiving favipiravir, remdesivir, interferon-β, and Kaletra^® were analyzed. Descriptive, univariate, and regression analyses were used. The costs and consequences of different drug regimens were significantly different (P value < 0.05); the highest and lowest costs belonged to remdesivir and Kaletra^®, respectively. The highest and lowest mean length of stay and mortality were related to remdesivir and favipiravir, respectively. Mortality did not differ significantly with various regimens. Length of stay was significantly shorter with favipiravir and Kaletra^® than interferon-β. Remdesivir had significantly the highest cost. Age presented a significantly positive relationship with mortality and length of stay. Besides, ICU admission significantly increased mortality, length of stay, and costs. Underlying diseases and low blood oxygen saturation contributed to mortality. COVID-19 correlation with age and underlying diseases is accordant with the published data. Given the highest costs and broad usage of remdesivir, besides controversies regarding its outcomes and side effects, a stricter evaluation of remdesivir benefits seems essential. Totally, COVID-19 therapeutic protocols should be selected carefully to optimize costs and outcomes.

Keywords: COVID-19; Coronavirus; Cost evaluation; Favipiravir; Remdesivir; SARS-CoV-2.

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