Estimation Of Direct Medical Costs Of Middle East Respiratory Syndrome Coronavirus Infection: A Single-Center Retrospective Chart Review Study

Figures & data

Table 1 Sociodemographic Characteristics Of The Patients

Characteristics	Patients (N=24)
Gender
Male, n (%)	9 (37.50)
Female, n (%)	15 (62.5)
Age, years; mean ± SD	52.54 ± 11.27
Marital status
Single, n (%)	2 (8.33)
Married, n (%)	13 (54.17)
Divorced, n (%)	9 (37.50)
Nationality
Saudi, n (%)	15 (62.50)
Non-Saudi, n (%)	9 (37.50)
Occupation
Health care worker, n (%)	8 (33.33)
Other, n (%)	16 (66.67)
Region
Riyadh, n (%)	20 (83.33)
Al-Madinah, n (%)	1 (4.16)
Al-Qaseem, n (%)	1 (4.16)
Aseer, n (%)	1 (4.16)
Tabouk, n (%)	1 (4.16)

Figure 1 Patient recruitment scheme.

Table 2 Medical Characteristics Of The Patients

Characteristics	Patients (N=24)
Comorbidities
Coronary artery disease, n (%)	1 (4.16)
Hypertension, n (%)	9 (37.50)
Diabetes, n (%)	14 (58.33)
Chronic kidney disease, n (%)	4 (16.66)
Liver disease, n (%)	2 (8.33)
Asthma, n (%)	1 (4.16)
Peripheral vascular disease, n (%)	1 (4.16)
Cancer, n (%)	3 (12.50)
Presenting symptoms
Fever, n (%)	12 (50)
Headache, n (%)	2 (8.33)
Cough, n (%)	9 (37.50)
Muscle aches, n (%)	1 (4.16)
Difficulty breathing, n (%)	3 (12.50)
Runny nose, n (%)	6 (25)
Sore throat, n (%)	10 (41.67)
Weight loss, n (%)	2 (8.33)
Swelling, n (%)	1 (4.16)
Pneumonia, n (%)	1 (4.16)
Chills (shivering), n (%)	10 (41.67)
Exposure to camels or their products within the past two weeks, n (%)	1 (4.16)
Exposure to a MERS case within the past two weeks, n (%)	11 (45.83)
Prior hospitalization in the past two weeks, n (%)	3 (12.5)
Acute respiratory distress syndrome, n (%)	2 (8.33)
H1N1 influenza, n (%)	4 (16.67)
Length of stay, days; mean ± SD	4.96 ± 7.29
Died, n (%)	2 (8.33)
Discharged, n (%)	22 (91.67)

Table 3 Reason For Admission And Time Of Diagnosis

Patient	Reason For Admission	Date Of Diagnosis After Admission	Length Of Stay	Status
1	Flu-like symptoms	Day 1	17 days	Died
2	Flu-like symptoms	Day 1	1 day	Discharged
3	Flu-like symptoms	Day 1	1 day	Discharged
4	Flu-like symptoms	Day 1	1 day	Discharged
5	Flu-like symptoms	Day 1	1 day	Discharged
6	Septic arthritis	Day 3	15 days	Discharged
7	Abdominal pain and dysuria	Day 1	2 days	Discharged
8	Flu-like symptoms	Day 1	1 day	Discharged
9	Black discoloration of toes	Day 6	10 days	Died
10	Flu-like symptoms	Day 1	1 day	Discharged
11	Flu-like symptoms	Day 1	2 days	Discharged
12	Flu-like symptoms	Day 1	1 day	Discharged
13	Flu-like symptoms	Day 1	1 day	Discharged
14	Flu-like symptoms	Day 1	1 day	Discharged
15	Came for a scheduled surgical procedure	Day 4	5 days	Discharged
16	Flu-like symptoms	Day 1	1 day	Discharged
17	Bleeding during pregnancy	Day 1	1 day	Discharged
18	Hyponatremia	Day 3	8 days	Discharged
19	Flu-like symptoms	Day 1	1 day	Discharged
20	Flu-like symptoms	Day 1	1 day	Discharged
21	Flu-like symptoms	Day 1	1 day	Discharged
22	Flu-like symptoms	Day 1	10 days	Discharged
23	Flu-like symptoms	Day 1	5 days	Discharged
24	Flu-like symptoms	Day 1	31 days	Discharged

Table 4 Direct Medical Cost Breakdown For The 24 Cases Of MERS

Items and costs		Patients
		1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17	18	19	20	21	22	23	24
Hospital stay	LOS, days	17	1	1	1	1	15	2	1	10	1	2	1	1	1	5	1	1	8	1	1	1	10	5	31
	ISO-Room, days at $173.33/day	14	1	1	1	1	15	2	1	10	1	2	1	1	1	5	1	1	8	1	1	1	10	5	31
	ICU-Room, days at $320.00/day	3
	Extended Care, days at $666.67/day	17					15	2		10		2	1			5			8				10	5	31
	HCW fees, days at $1051.43/day	17	1	1	1	1	15	2	1	10	1	2	1	1	1	5	1	1	8	1	1	1	10	5	31
	PPE, $5.66 each	17	1	1	1	1	15	2	1	10	1	2	1	1	1	5	1	1	8	1	1	1	10	5	31
Diagnostic and laboratory tests*	CBC+ U&E, $122.67	17	1	1	1	1	15	2	1	10		2	1			5		1	8				10	5	31
	Cardiac Enzymes + ECG, $213.33					1			1	1
	RFT, $160.00 each	14	1			1	15		1	10						5		1	8				10	5	30
	LFT, ALT, Serum albumin, $240.00	17					15	2		10						5		1	8				10	5	15
	ESR+CRP, $37.33	17					15									5
	Chest X-ray, $53.33	13			1	1	1		1	1		1				5		1	6				3	3
	Chest CT scan, $160.00	17
	Nasal swab culture, $21.33	5	1	1	1	1	3	1	1	1	1	1	1	1	1	2	6	1	6	8	1	1	3	1	8
	Oral culture, $61.60	1						1
	Sputum culture, $10.67	2								1										1
	Blood culture, $26.67	10								1									1				1	1	1
	Other culture laboratory, $61.60	1								1									1					1	1
	MRSA screen, $18.67	3
	Anti-DNA, $26.67	5	1	1	1	1	3	1	1	2	1	1	1	1	1	2	6	1	6	8	1	1	3	1	8
	AFB culture laboratory, $18.67						1
Antibiotics and antiviral	Intravenous infusion, $53.33/day	31					15			29		4				5							16	6	30
	Ribavirin, $440.53 each	10								1
	Interferon-α2 (prefilled syringe), $28.27/day	1								1
	Oseltamivir, $35.31/day	1		1						3														1	5
	Azithromycin, $4.22/day	5								3														3	1
	Clarithromycin, $11.73/day					1
	Clindamycin P, $13.44/day									5
	Vancomycin, $19.20/day	6								5															5
	Ceftriaxone, $24.11/day	4								5														2
	Amoxicillin-clavulanate, $33.33/day					1	4								1								1
	Tazocin, $43.40/day	9																					8
	Meropenem, $31.73/day	5								7
	Cefepime, $32.32/day																								9
	Imipenem, $51.04/day																								4
	Cefuroxime, $1.95/day					1										4
Other medications	Paracetamol oral, $7.33/day		1	1	1	1				5	1		1		1	2							7	5	8
	Paracetamol parenteral, $9.88/day											2
	Ascorbic acid, $0.81/day		1		1						1	2	1		1
	Cost of other medications given during hospitalization	$4814.86	$1.61	$1.57	$1.27	$0.18	$2222.02	$0.00	$8.19	$6505.58 24,395.92	$43.60	$250.50	$24.67	$19.75	$46.13	$1288.30	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$517.68	$123.43	$2492.23
Total and average cost	Total cost per patient	$55,489.77	$1572.79	$1445.50	$1463.83	$1,880.19	$39,856.70	$4469.10	$1835.94	$33,819.54	$1330.16	$4626.04	$2083.06	$1444.83	$1505.23	$14,968.28	$1518.41	$1854.41	$20,103.58	$1614.41	$1278.41	$1278.41	$26,330.90	$12,971.30	$75,987.95
	Cost, mean ± SD	$12,947.03 ± 19,923.14

Notes: Values in highlighted cells indicate number of days or interventions, as appropriate. *The cost of the detection of influenza H1N1 virus by polymerase chain reaction (PCR) test was not included due to the lack of any national cost estimation.

Abbreviations: LOS, length of stay; ISO-Room, isolation room; ICU-Room, intensive care unit; HCW, health care workers; PPE, personal protective equipment; CBC, complete blood count; U&E, urea and electrolytes; ECG, electrocardiogram; RFT, renal function test; LFT, liver function test; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; CT, computed tomography; AFB, Acid-Fast Bacilli.