Nathalie Vernaz1, Thomas Agoritsas2, Alexandra Calmy3, Angèle Gayet-Ageron4, Gabriel Gold5, Arnaud Perrier6, Fabienne Picard7, Virginie Prendki8, Jean-Luc Reny9, Caroline Samer10, Jérôme Stirnemann9, Pauline Vetter11, Marie-Céline Zanella12, Dina Zekry8, Stéphanie Baggio13. 1. Medical Directorate, Finance Directorate, Geneva University Hospitals, Geneva University, Switzerland. 2. Division of General Internal Medicine and Division of Clinical Epidemiology, University Hospitals of Geneva, Switzerland / Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. 3. Division of Infectious Diseases, HIV/AIDS Unit, Geneva University Hospitals, Switzerland. 4. CRC and Division of Clinical Epidemiology, Department of Health and Community Medicine, University of Geneva and University Hospitals of Geneva, Switzerland. 5. Service of Geriatrics, Department of Internal Medicine Rehabilitation and Geriatrics, University Hospitals and University of Geneva, Switzerland. 6. Medical Directorate, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland / Department of General Internal Medicine, Geneva University Hospitals, Switzerland. 7. Division of Neurology, Department of Clinical Neurosciences, University of Geneva and University Hospitals of Geneva, Switzerland. 8. Division of Internal Medicine for the Aged, University of Geneva and University Hospitals of Geneva, Thônex, Switzerland. 9. Department of General Internal Medicine, Geneva University Hospitals, Switzerland. 10. Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Switzerland. 11. Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Switzerland. 12. Division of Infectious Diseases, Geneva University Hospitals, Switzerland. 13. Division of Prison Health, University of Geneva and University Hospitals of Geneva, Thônex, Switzerland / Office of Corrections, Department of Justice and Home Affairs of the Canton of Zurich, Zurich, Switzerland.
Abstract
AIMS OF THE STUDY: Hydroxychloroquine and lopinavir/ritonavir have been used as experimental therapies to treat COVID-19 during the first wave of the pandemic. Randomised controlled trials have recently shown that there are no meaningful benefits of these two therapies in hospitalised patients. Uncertainty remains regarding the potential harmful impact of these therapies as very early treatments and their burden to the health care system. The present study investigated the length of hospital stay (LOS), mortality, and costs of hydroxychloroquine, lopinavir/ritonavir or their combination in comparison with standard of care among patients hospitalised for coronavirus disease 2019 (COVID-19). METHODS: This retrospective observational cohort study took place in the Geneva University Hospitals, Geneva, Switzerland (n = 840) between 26 February and 31 May 2020. Demographics, treatment regimens, comorbidities, the modified National Early Warning Score (mNEWS) on admission, and contraindications to COVID-19 treatment options were assessed. Outcomes included LOS, in-hospital mortality, and drug and LOS costs. RESULTS: After successful propensity score matching, patients treated with (1) hydroxychloroquine, (2) lopinavir/ritonavir or (3) their combination had on average 3.75 additional hospitalisation days (95% confidence interval [CI] 1.37–6.12, p = 0.002), 1.23 additional hospitalisation days (95% CI −1.24 – 3.51, p = 0.319), and 4.19 additional hospitalisation days (95% CI 1.52–5.31, p <0.001), respectively, compared with patients treated with the standard of care. Neither experimental therapy was significantly associated with mortality. These additional hospital days amounted to 1010.77 additional days for hydroxychloroquine and hydroxychloroquine combined with lopinavir/ritonavir, resulting in an additional cost of US$ 2,492,214 (95%CI US$ 916,839–3,450,619). CONCLUSIONS: Prescribing experimental therapies for COVID-19 was not associated with a reduced LOS and might have increased the pressure put on healthcare systems.
AIMS OF THE STUDY: Hydroxychloroquine and lopinavir/ritonavir have been used as experimental therapies to treat COVID-19 during the first wave of the pandemic. Randomised controlled trials have recently shown that there are no meaningful benefits of these two therapies in hospitalised patients. Uncertainty remains regarding the potential harmful impact of these therapies as very early treatments and their burden to the health care system. The present study investigated the length of hospital stay (LOS), mortality, and costs of hydroxychloroquine, lopinavir/ritonavir or their combination in comparison with standard of care among patients hospitalised for coronavirus disease 2019 (COVID-19). METHODS: This retrospective observational cohort study took place in the Geneva University Hospitals, Geneva, Switzerland (n = 840) between 26 February and 31 May 2020. Demographics, treatment regimens, comorbidities, the modified National Early Warning Score (mNEWS) on admission, and contraindications to COVID-19 treatment options were assessed. Outcomes included LOS, in-hospital mortality, and drug and LOS costs. RESULTS: After successful propensity score matching, patients treated with (1) hydroxychloroquine, (2) lopinavir/ritonavir or (3) their combination had on average 3.75 additional hospitalisation days (95% confidence interval [CI] 1.37–6.12, p = 0.002), 1.23 additional hospitalisation days (95% CI −1.24 – 3.51, p = 0.319), and 4.19 additional hospitalisation days (95% CI 1.52–5.31, p <0.001), respectively, compared with patients treated with the standard of care. Neither experimental therapy was significantly associated with mortality. These additional hospital days amounted to 1010.77 additional days for hydroxychloroquine and hydroxychloroquine combined with lopinavir/ritonavir, resulting in an additional cost of US$ 2,492,214 (95%CI US$ 916,839–3,450,619). CONCLUSIONS: Prescribing experimental therapies for COVID-19 was not associated with a reduced LOS and might have increased the pressure put on healthcare systems.