Clinical characteristics and health care cost among patients successfully treated for COVID-19 in China: A Descriptive Study

Objective: To clarify the clinical and medical expense characteristics Methods: In this retrospective, single-center study, 55 cured cases with confirmed COVID-19 were analyzed for demographic, epidemiological, clinical, and radiological features and medical expense data. Results: The average age of the 54 successfully treated patients with COVID-19 was 53.2 years old (SD 19.0), including 27 men and 27 women. Off this, 31 (57.4%) patients had chronic diseases. Patients commonly had clinical manifestations of fever (45 [83.3%] patients), cough (29[54.7%] patients), expectoration (28 [51.9%] patients), fatigue (24[44.4%] patients) and diarrhea (8[14.8%] patients) on admission. There was a 10-day interval from the onset of signs and symptoms to hospital admission. About 80% of them got recovery after a two-week treatment. The mean interval from the onset of signs and symptoms to hospital discharge was 20.5 (IQR 16-29) days. The median total medical expense of the treated patient, in general, was 2579.6 (IQR 1366.1-4837.6) U.S. dollars. Still, the median medical expense was 8904.1 (IQR 6660.1- 27143.8) U.S. dollars in patients with more than five comorbid illnesses during the treatment. Conclusion: There is a 3-week interval from the onset of signs and symptoms to cure, and most hospitalized patients get recovery within two weeks. The total medical expense of cases with more than five comorbid conditions during the treatment is higher. Quite a few COVID-19 cases with other serious diseases are likely to account for most of the total medical expenses.


Introduction
Since Dec 8, 2019, COVID-19 epidemic occurred in Wuhan, Hubei province, China. [1][2][3][4] In the past months, COVID-19 has resulted in more than 3.6 million confirmed cases, and 250 thousand died cases globally, exceeding the impacts of confirmed cases of SARS (8273 cases, 775 deaths) and MERS (2494 cases and 858 deaths). [5][6][7] COVID-19 infection has clinical symptoms of respiratory diseases resembling SARS, with fever, fatigue, dry cough as the primary manifestations. [8][9][10][11] Most of the patients were moderate to mild, with a good prognosis, and a few were in critical condition. 12,13 Based on the current epidemiological evidence, the incubation period of COVID-19 is 1-14 days, mostly 3-7 days. [14][15][16] There is evidence of human-to-human transmission, and asymptomatic patients may also become the source of infection. 17,18 The main transmission routes are respiratory droplet transmission and contact transmission. 19 People of all ages are susceptible. 20,21 Children show better prognosis than the elderly and adults with chronic diseases have poor. 22 At present, information regarding clinical characteristics and health care cost of patients successfully treated for COVID-19 is scarce. 23,24 In this study, we did a comprehensive exploration of the clinical and health economic features of 54 successfully treated patients with confirmed COVID-19 admitted to Henan Provincial People's Hospital, Zhengzhou, which cured all the patients with COVID-19 to be reported on.

Study design and participants
For this retrospective, single-center study, we recruited patients from Jan 23 to Feb 27, 2020, at Henan Provincial People's Hospital in Zhengzhou, China. Henan Provincial People's Hospital is a Regional Medical Center of central China with the Infectious Disease Department as its critical specialized department. As COVID-19 medical observation and hospitalization institution designated by the Chinese government, the hospital received all suspected patients with COVID-19 related symptoms (fever or respiratory symptoms) from the whole of Henan province and surrounding provinces without selectivity.
All patients diagnosed as having COVID-19, according to World Health organization (WHO) interim guidance was enrolled in this study. 25 All the data of included cases have been reported to provincial and national CDCs. No patients of this retrospective study were directly involved in the recruitment and design and identified through the anonymized database. The study was approved by the Henan Provincial People's Hospital Ethics Committee.

Procedures
The demographical, clinical, and health care cost data were obtained from the Hospital Information System of Henan Provincial People's Hospital. Clinical outcomes were followed up to the discharge date of the last patient (Mar 10, 2020). In terms of data missing from the records or clarification was needed, we obtained data by direct communication with healthcare providers of the Infectious Disease Department of Henan Provincial People's Hospital. There was no missing health economic data. All data were checked by three independent physicians (LM, LF, and CRR).

Outcomes
We described demographic characteristics (age, sex, marriage, etc.) and epidemiological characteristics (allergy drug, morbid chronic disease, exposure history, etc.); Clinical characteristics(signs and symptoms at admission, duration of Signs and symptoms at admission, comorbidities, etc.); Chest radiography and Computed Tomography (CT) findings; Treatment (Oxygen therapy, Mechanical ventilation, traditional Chinese medicine treatment, etc.) and outcome (cure rate); Health economic characteristics (total medical expenses and composition) and the correlations between total medical expense and comorbid chronic medical illness.

Statistical analysis
We presented continuous variables as mean (SD) and median (IQR), respectively, and categorical variables as count (%). We used linear regression to analyze the correlation between the total medical expense and comorbid chronic medical illnesses among the sampled patients. P<0.05 was considered statistically significant. Statistical analysis was performed using SPSS (Version 26.0).

Role of the funding source
The funder has no role in study design, analysis, and interpretation of the study findings.

Results
A total of 54 patients with COVID-19 were included in this study, and each of them come from different families. The mean age for all patients was 54.2 years old, ranging from 20 to 90 years old, and patients aged 50-59 were most numerous (31.5%). Half of the patients were male (50.0%). 23 (42.6%) patients lived in rural areas. Off these, 31(56.4%) patients had chronic diseases, and ten (18.5%) had more than one chronic disease. Five patients had a self-reported medical history of Penicillin or Piperacillin hypersensitivity (table 1).

Discussion
This is an extended descriptive study on the clinical, epidemiological, and health care cost of 54 patients successfully treated patients with COVID-19, who were hospitalized in Henan Provincial People's Hospital. As a pandemic disease identified by WHO, COVID-19 is resulting in more death with an estimated case fatality rate ranging from 0.15% to 11%. [26][27][28][29] At data cut off for this study, no case of the cases. As new reports of re-infections among previously treated COVID-19 cases come from some countries, including China, the health status of the discharged patients' needs continuous follow-up.
In the present study, we found that most patients were middle-and old-aged, with 1:1 male-female ratio.
The mean age (53.2[SD 19.0])) is younger than data reported by Chen et al. and Zhang et al. 29,30 56.4% of the patients had at least one chronic illness on admission. During the treatment, 78.2% of them developed comorbid conditions, many of them progressed into organ dysfunction, including acute respiratory injury (ARDS), septic shock, and acute renal injury. Therefore, early identification and timely treatment of critical cases are crucial for preventing disease and multiorgan failure. Although fever (83.6%), cough (55.6%), expectoration (50.9%), fatigue (44.4%) and diarrhea (14.5%) were the most common symptoms in the 54 patients, the prevalence of symptoms in this cohort was significantly lower than previously reported data. 21,31 This might be one of the reasons why all 54 patients were cured, it is known that fever severity correlates with disease severity and risk of developing ARDS. 32 These individuals where many were asymptomatic carriers or that the disease may represent a cohort of mild infection. They also were caught early and treated. It's important to note that there was a 10-day interval from the onset of signs and symptoms to hospital admission. These asymptomatic or mild patients may cause more infections during the interval. Considering the human-to-human transmission characteristics and the unknown transmission rate of COVID-19, it is necessary to reduce the population's mobility during the pandemic.
In terms of treatment, minimizing treatment duration and comorbidities are critical for patient management. Most hospitalized patients were given treatments according to the COVID-19 protocol recommended by Chinese National Health Commission (version 1 was published on Jan 23, 2020, the latest version 7 was released on Mar 4, 2020), including oxygen therapy, antibiotics, antivirals, Glucocorticoids, and traditional Chinese medicine. Considering that old age and comorbidities might be associated with low immunity and increased mortality, many of them were given a combination of antibiotics and intravenous immunoglobulin to prevent infection and strengthen their immune system. For patients with ARDS, steroids (methylprednisolone 1-2 mg/kg per day) were used for as short a duration of treatment as possible. In general, the treatments were effective, with all patients cured, and about 80% of them got recovery within the two-weeks treatment duration.

Ethics approval and consent to participate
All enrolled patients gave written informed consent before the clinical treatment in Henan Provincial People's Hospital. The ethics committee of Henan Provincial People's Hospital ruled that no formal ethics approval was required in this particular case.

Consent for publication
All authors have approved the final manuscript and consented for the publication.