Assessment of COVID-19 hospitalisation cost and its associated factors in Nepal: a descriptive cross-sectional study

This study aimed to assess the coronavirus disease 2019 (COVID-19) hospitalisation costs and its associated factors on Nepalese households during the second wave of the pandemic, within the context of Nepal's COVID-19 response.

A cost-descriptive cross-sectional study.

Kathmandu Metropolitan City, Nepal.

We enrolled 306 hospitalised patients.

Telephonic interviews were conducted with COVID-19 patients between May and July 2022. Cost was assessed from a patient's perspective. We assessed factors associated with the medical cost of COVID-19 treatment services using a generalised linear model with gamma distribution and log link in both bivariable and multivariable models for estimating coefficients and confidence intervals. Data were analysed using STATA version 13, adjusting for the potential confounders: socio-demographic characteristics, type of hospital, intensive care unit (ICU) requirement, lead time to hospital admission and number of days at hospital stay.

The total median cost for hospitalisation was US$ 754.9. The median direct medical, direct non-medical and indirect costs were US$ 624.4, US$ 49.3 and US$ 493.02, respectively. After adjusting for potential confounders, the cost of COVID-19 treatment was 6.9 times higher among those admitted to private hospital (95% CI 5.72 to 8.32, p<0.01), 5 times higher among those admitted to community hospital (95% CI 3.26 to 7.68, p<0.01) and 7.03 times higher among multiple hospitals (95% CI 4.91 to 10.06, p<0.01) as compared with public hospitals. Similarly, compared with patients who did not require ICU support, the cost of COVID-19 treatment was higher by 2.17 times among those who required ICU support (95% CI 1.67 to 2.81, p<0.01). With each day increase in lead time to hospital admission, the cost of COVID-19 treatment was higher by 1.05 times, adjusting for the confounders (95% CI 1.01 to 1.08, p<0.01). With each day increase in hospital stay, the cost of COVID-19 treatment was higher by 1.03 times (95% CI 1.01 to 1.04, p<0.01) adjusting for the confounders.

The cost of the COVID-19 treatment was beyond the average monthly income of Nepalese, indicating adverse consequences from the financial burden of a household. The direct medical cost was associated with the type of hospital, requirement of ICU, lead time to hospital admission, and length of hospital stay. Therefore, it is urgent to address the issue of high medical expenses, particularly to strengthen the health system's resilience against unforeseen crises and pandemics.