COVID-19 and Diagnosis-Related Group in one of the university hospitals in Malaysia: patient classifications and associated hospital costs

Background: The coronavirus disease 2019 (COVID-19) pandemic impacted healthcare systems in many aspects, with the most immediate need being the increased healthcare burden and healthcare costs. Nevertheless, the magnitude of hospital workload related to COVID-19 in university hospitals in Malaysia is unknown. Patients’ classification based on Diagnosis-Related Group (DRG) helps the hospital to analyse the complexity of the patients and the required hospital costs of the patient population they are treating. Hospitals can then allocate healthcare resources depending on the anticipated needs of patients within a certain DRG category accordingly. This study aimed to determine the DRG and the hospital costs of COVID-19 cases in one of the university hospitals in Malaysia. Methods: The study was conducted at University Malaya Medical Centre and data on hospital admissions related to COVID-19 in 2021 were coded with International Classification of Diseases 10th Revision (ICD-10) and ICD 9th Revision, Clinical Modification (ICD-9-CM). The combination generated DRG codes, which were A-4-13-I, A-4-13-II and A-4-13-III for mild, moderate and severe classification of COVID-19 respectively. Simultaneously, healthcare resource utilisation and costs were estimated for the codes through clinical pathways. The classification of COVID-19 patients based on DRG was presented as frequencies and percentages while cost data were reported in US dollar (USD) (price year 2021). Results: A total of 4,889 patients with COVID-19 diagnosis were admitted to the hospital. Of these patients, 4,813/4,889 (98%) had a primary diagnosis of COVID-19 while the remaining patients were admitted for other medical reasons such as elective admission for clinical procedures, but were found to be COVID-19 positive. Of the 4,813 patients with a primary diagnosis of COVID-19, 3,909 (81%) were admitted with mild COVID-19 (A-4-13-I), 630 (13%) had moderate COVID-19 (A-4-13-II) and 274 (6%) were admitted for severe COVID-19 (A-4-13-III). The total costs incurred by the hospital for COVID-19 inclusive of the direct medical costs, special allowance for healthcare workers for COVID-19 services, costs of decanting for non-COVID-19 patients to other healthcare facilities and expenditure for consumables and equipment related to COVID-19 management were approximately USD 29.5 million. Conclusions: COVID-19 resulted in significant economic implications for the centre, as it comprised 12% of the total hospital expenditure and resulted in the reduction of the volume and cessation of several healthcare services before the pandemic.