Economic burden of COVID-19 on hospitalized patients: a cross-sectional study from Semnan, Iran

BACKGROUND: One of the responsibilities of health systems is to protect citizens from the financial burdens caused by disease. This study aimed to estimate the economic burden of the coronavirus disease 2019 (COVID-19) on hospitalized patients and identifying its determinants. METHODS: The current cross-sectional study was conducted during the sixth peak of COVID-19 in Iran (summer and fall 2021) with the participation of 400 hospitalized patients at Kowsar Hospital in Semnan from the patients' perspective. The data was collected using the patients' medical records and through interviewing with the patients. We used a researcher-made questionnaire, whose content validity was confirmed by scores of 0.91 and 0.93, respectively, for content validity ratio (CVR) and content validity index (CVI). Depending on the nature of the independent and dependent variables, student's t-test, analysis of variance (ANOVA), Chi-square, linear regression, and Tukey's post-hoc tests were used. RESULTS: The economic estimations revealed that hospitalized COVID-19 patients and their families paid 2773.43 USD (116484080 IRR) monthly, of which 1833.43 USD (77004080 IRR) (66%) was related to direct medical costs, 357.97 USD (15035000 IRR) (13%) to direct non-medical costs, and 582.02 USD (24445000 IRR) (21%) to indirect costs. In addition to the factors relating to the severity of the disease and its side effects, a wide range of demographic and contextual factors, including age, gender, residence status, residence region (urban or rural), type of basic and supplementary insurance, location of care, presence of an underlying disease, and receiving medication for the underlying disease had an impact on the total cost. CONCLUSIONS: According to our results, COVID-19 hospitalization had a significant financial impact on hospitalized patients and their families, just like complicated procedures or chronic severe illnesses. We also identified significant geographic, economic, and employment-related health inequities.