The economic impact of COVID-19: a comparative cost analysis of ICU hospitalizations before and during the pandemic

• Average ICU costs tripled during COVID-19 compared to the pre-pandemic period. • Human resources drove ICU costs, accounting for over 78 % during the pandemic. • Patients needing ventilation, dialysis or surgery had significantly higher ICU costs. • The study offers a replicable micro and macro-costing method for economic evaluations. • Novel comparative analysis of ICU costs before and during the COVID-19 pandemic. The COVID-19 economic impact on health institutions has been discussed since the beginning of the pandemic, and the repercussions in different spheres were enormous. The economic evaluation in health became necessary as a management tool. To describe and compare the hospitalization costs in Intensive Care Units (ICUs) and the patients' clinical and demographic variables, before and during the COVID-19 pandemic. Partial economic evaluation of patients admitted to four ICUs, in a Brazilian reference center, in two periods: pre-pandemic (03/30/19 ‒ 06/30/19) and pandemic (03/30/20 ‒ 06/30/20). Observational cohort study. Micro and macro costing methodology; clinical and demographic variables were considered for the comparative analysis. In 2019, 521 hospitalizations were analyzed. Patients were predominantly male (61%), between 31- and 60-years old (48. 2%) and of white race (75. 4%). In 2020, 610 hospitalizations were analyzed: 60. 3% male, 51. 6% > 60-years old and 65. 2% white race. All ICUs had an increase in deaths (2019: average of 26. 9%; 2020: average of 48. 8%). The average total hospitalization costs and the average patient-day cost in 2019 was US 6051. 01 and US 787. 48, respectively; in 2020, US 19, 492. 73 and US 1542. 74. Human resources was the component with the highest cost (2019: 51. 6%; 2020: 78. 2%). Patients who require additional therapeutic procedures had a higher average cost in 2020. During COVID, patients were older (> 60-years), a higher percentage of patients identified as mixed race, the death rate was significantly higher, and the length of stay was significantly higher, resulting in the outcome “discharge”. The COVID cost was significantly higher. The main cost component was human resources, mainly during the COVID pandemic. Additional therapeutic procedures were associated with higher costs.