Jang Su Yeon, Seon Jeong-Yeon, Yoon Seok-Jun, Park So-Youn, Lee Seung Heon, Oh In-Hwan
Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea.
Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea.
Risk Manag Healthc Policy. 2021 May 18;14:2021-2033. doi: 10.2147/RMHP.S292538. eCollection 2021.
No previous investigations of coronavirus disease 2019 (COVID-19) have estimated medical expenses, length of stay, or factors influencing them using administrative datasets. This study aims to fill this research gap for the Republic of Korea, which has over 10,000 confirmed COVID-19 cases.
Using the nationwide health insurance claims data of 7590 confirmed COVID-19 patients, we estimated average medical expenses and inpatient days per patient, and performed multivariate negative binomial, and gamma regressions to determine influencing factors for higher outcomes.
According to the results, COVID-19 patients with history of ICU admission, chest CT imaging, lopinavir/ritonavir and hydroxychloroquine use stayed longer in the hospital and spent more on medical expenses, and anti-hypertensive drugs were insignificantly associated with the outcomes. Female patients stayed longer in the hospital in the over 65 age group but spent less in medical expenses that the 20-39 group. In the 40-69 age group, patients with health insurance stayed longer in the hospital and spent more on medical expenses than those aged over 65 years. Comorbidities did not affect outcomes in most age groups.
In summary, contrary to popular beliefs, medical expenses and length of hospitalization were mostly influenced by age, and not by comorbidities, anti-viral, or anti-hypertensive drugs. Thus, responses should focus on infection prevention and control rather than clinical countermeasures.
以往关于2019冠状病毒病（COVID-19）的研究均未利用行政数据集估算医疗费用、住院时长或影响这些因素。本研究旨在填补韩国这方面的研究空白，韩国已有超过10000例COVID-19确诊病例。
利用7590例COVID-19确诊患者的全国健康保险理赔数据，我们估算了每位患者的平均医疗费用和住院天数，并进行了多变量负二项式和伽马回归分析，以确定影响更高结果的因素。
结果显示，有重症监护病房（ICU）入院史、胸部CT成像、使用洛匹那韦/利托那韦和羟氯喹的COVID-19患者住院时间更长，医疗费用更高，而抗高血压药物与这些结果的关联不显著。65岁以上年龄组的女性患者住院时间更长，但医疗费用低于20-39岁组。在40-69岁年龄组中，有健康保险的患者住院时间更长，医疗费用高于6岁以上患者。合并症在大多数年龄组中对结果没有影响。
总之，与普遍看法相反，医疗费用和住院时长主要受年龄影响，而非合并症、抗病毒药物或抗高血压药物。因此，应对措施应侧重于感染预防和控制，而非临床对策。
