This study answers the question of whether the health care costs of managing COVID-19 in preexisting cardiovascular diseases (CVD) patients increased or decreased as a consequence of evidence-based efforts to optimize the initial COVID-19 management protocol in a CVD group of patients. A retrospective cohort study was conducted in preexisting CVD patients with COVID-19 in Hamad Medical Corporation, Qatar. From the health care perspective, only direct medical costs were considered, adjusted to their 2021 values. The impact of revising the protocol was a reduction in the overall costs in non-critically ill patients from QAR15,447 (USD 4243) to QAR4337 (USD 1191) per patient, with an economic benefit of QAR11,110 (USD 3051). In the critically ill patients, however, the cost increased from QAR202,094 (USD 55,505) to QAR292,856 (USD 80,433) per patient, with added cost of QAR90,762 (USD 24,928). Overall, regardless of critical care status, the optimization of the initial COVID-19 protocols in patients with preexisting CVD did not reduce overall health care costs, but increased it by QAR80,529 (USD 22,117) per patient.
Multiple studies conducted in different countries have shown that the most common preexisting comorbid conditions among patients requiring intensive care unit (ICU) admission for the coronavirus disease 2019 (COVID-19) are cardiovascular diseases such as hypertension, heart failure, cardiomyopathy, and dyslipidemia, where high fatality rate is reported.1, 2, 3
Several recent studies have reported that the clinical manifestation of COVID-19 infection may exceed the respiratory system to involve other organs, including the cardiovascular system.4, 5, 6 While the exact pathogenesis of cardiovascular complications related to COVID-19 is not well-established yet, a wide range of injuries has been described in the literature, including arrhythmias, acute coronary syndrome, myocarditis, and heart failure.4,5 Furthermore, some of the medications currently used in the course of COVID-19 treatment have been linked to cardiovascular adverse events such as hydroxychloroquine.4, 5, 6 This situation is especially dire in patients with underlying CVD since they are a high-risk population ab initio with a propensity to more severe infections and subsequent higher mortality rates.2,3 The uncertainty about the exact therapeutic approach to managing COVID-19 clinical syndrome led to the hurried development of several national and international clinical guidelines that comprised antivirals, antibiotics, antiprotozoal, and immunosuppressant agents.7
Based on the study perspective and assumptions, revising the initial national protocol of management of COVID-19 in preexisting CVD patients in HMC, and although presumably targeted cost minimization, increased the overall health care cost of therapy, mainly driven by the cost of hospitalization in the ICU ward. Cost cutting revision of the protocol by including lesser spending on medications, therefore, may not be effective in isolation from the consideration of the duration of ICU stay. Overall, our findings suggest that the changes in the use of medications, devices, and laboratory and diagnostic investigations, as well as the stratification of patients according to their critical care status, would likely affect resource consumption by preexisting CVD patients with COVID-19. Therefore, as new protocols emerge, there is a need to continually update the cost analysis of COVID-19 management for guiding decisions regarding any future resource consumption.