Early experimental COVID-19 therapies: associations with length of hospital stay, mortality and related costs.
Identifieur interne : 001381 ( Main/Exploration ); précédent : 001380; suivant : 001382Early experimental COVID-19 therapies: associations with length of hospital stay, mortality and related costs.
Auteurs : Nathalie Vernaz [Suisse] ; Thomas Agoritsas [Canada] ; Alexandra Calmy [Suisse] ; Angèle Gayet-Ageron [Suisse] ; Gabriel Gold [Suisse] ; Arnaud Perrier [Suisse] ; Fabienne Picard [Suisse] ; Virginie Prendki [Suisse] ; Jean-Luc Reny [Suisse] ; Caroline Samer [Suisse] ; Jérôme Stirnemann [Suisse] ; Pauline Vetter [Suisse] ; Marie-Céline Zanella [Suisse] ; Dina Zekry [Suisse] ; Stéphanie Baggio [Suisse]Source :
- Swiss medical weekly [ 1424-3997 ] ; 2020.
Descripteurs français
- KwdFr :
- Adolescent (MeSH), Adulte (MeSH), Adulte d'âge moyen (MeSH), Antiviraux (administration et posologie), Antiviraux (effets indésirables), Antiviraux (usage thérapeutique), Association de médicaments (MeSH), Association médicamenteuse (MeSH), Comorbidité (MeSH), Durée du séjour (statistiques et données numériques), Dépenses de santé (MeSH), Enfant (MeSH), Enfant d'âge préscolaire (MeSH), Facteurs sexuels (MeSH), Facteurs socioéconomiques (MeSH), Facteurs âges (MeSH), Humains (MeSH), Hydroxychloroquine (administration et posologie), Hydroxychloroquine (effets indésirables), Hydroxychloroquine (usage thérapeutique), Indice de gravité de la maladie (MeSH), Jeune adulte (MeSH), Lopinavir (administration et posologie), Lopinavir (effets indésirables), Lopinavir (usage thérapeutique), Mortalité hospitalière (tendances), Nourrisson (MeSH), Pandémies (MeSH), Ritonavir (administration et posologie), Ritonavir (effets indésirables), Ritonavir (usage thérapeutique), Sujet âgé (MeSH), Sujet âgé de 80 ans ou plus (MeSH), Traitements en cours d'évaluation (méthodes), Études rétrospectives (MeSH).
- MESH :
- administration et posologie : Antiviraux, Hydroxychloroquine, Lopinavir, Ritonavir.
- effets indésirables : Antiviraux, Hydroxychloroquine, Lopinavir, Ritonavir.
- méthodes : Traitements en cours d'évaluation.
- statistiques et données numériques : Durée du séjour.
- tendances : Mortalité hospitalière.
- usage thérapeutique : Antiviraux, Hydroxychloroquine, Lopinavir, Ritonavir.
- Adolescent, Adulte, Adulte d'âge moyen, Association de médicaments, Association médicamenteuse, Comorbidité, Dépenses de santé, Enfant, Enfant d'âge préscolaire, Facteurs sexuels, Facteurs socioéconomiques, Facteurs âges, Humains, Indice de gravité de la maladie, Jeune adulte, Nourrisson, Pandémies, Sujet âgé, Sujet âgé de 80 ans ou plus, Études rétrospectives.
English descriptors
- KwdEn :
- Adolescent (MeSH), Adult (MeSH), Age Factors (MeSH), Aged (MeSH), Aged, 80 and over (MeSH), Antiviral Agents (administration & dosage), Antiviral Agents (adverse effects), Antiviral Agents (therapeutic use), COVID-19 (drug therapy), COVID-19 (epidemiology), COVID-19 (mortality), Child (MeSH), Child, Preschool (MeSH), Comorbidity (MeSH), Drug Combinations (MeSH), Drug Therapy, Combination (MeSH), Health Expenditures (MeSH), Hospital Mortality (trends), Humans (MeSH), Hydroxychloroquine (administration & dosage), Hydroxychloroquine (adverse effects), Hydroxychloroquine (therapeutic use), Infant (MeSH), Length of Stay (statistics & numerical data), Lopinavir (administration & dosage), Lopinavir (adverse effects), Lopinavir (therapeutic use), Middle Aged (MeSH), Pandemics (MeSH), Retrospective Studies (MeSH), Ritonavir (administration & dosage), Ritonavir (adverse effects), Ritonavir (therapeutic use), SARS-CoV-2 (MeSH), Severity of Illness Index (MeSH), Sex Factors (MeSH), Socioeconomic Factors (MeSH), Therapies, Investigational (methods), Young Adult (MeSH).
- MESH :
- chemical , administration & dosage : Antiviral Agents, Hydroxychloroquine, Lopinavir, Ritonavir.
- chemical , adverse effects : Antiviral Agents, Hydroxychloroquine, Lopinavir, Ritonavir.
- chemical , therapeutic use : Antiviral Agents, Hydroxychloroquine, Lopinavir, Ritonavir.
- drug therapy : COVID-19.
- epidemiology : COVID-19.
- methods : Therapies, Investigational.
- mortality : COVID-19.
- statistics & numerical data : Length of Stay.
- trends : Hospital Mortality.
- Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Child, Child, Preschool, Comorbidity, Drug Combinations, Drug Therapy, Combination, Health Expenditures, Humans, Infant, Middle Aged, Pandemics, Retrospective Studies, SARS-CoV-2, Severity of Illness Index, Sex Factors, Socioeconomic Factors, Young Adult.
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.
DOI: 10.4414/smw.2020.20446
PubMed: 33382449
Affiliations:
Links toward previous steps (curation, corpus...)
Le document en format XML
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sortKey="Vernaz, Nathalie" sort="Vernaz, Nathalie" uniqKey="Vernaz N" first="Nathalie" last="Vernaz">Nathalie Vernaz</name><affiliation wicri:level="1"><nlm:affiliation>Medical Directorate, Finance Directorate, Geneva University Hospitals, Geneva University, Switzerland.</nlm:affiliation><country xml:lang="fr">Suisse</country><wicri:regionArea>Medical Directorate, Finance Directorate, Geneva University Hospitals, Geneva University</wicri:regionArea><wicri:noRegion>Geneva University</wicri:noRegion></affiliation></author><author><name sortKey="Agoritsas, Thomas" sort="Agoritsas, Thomas" uniqKey="Agoritsas T" first="Thomas" last="Agoritsas">Thomas Agoritsas</name><affiliation wicri:level="1"><nlm:affiliation>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.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>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</wicri:regionArea><wicri:noRegion>ON</wicri:noRegion></affiliation></author><author><name sortKey="Calmy, Alexandra" sort="Calmy, Alexandra" uniqKey="Calmy A" first="Alexandra" last="Calmy">Alexandra Calmy</name><affiliation wicri:level="1"><nlm:affiliation>Division of Infectious Diseases, HIV/AIDS Unit, Geneva University Hospitals, Switzerland.</nlm:affiliation><country xml:lang="fr">Suisse</country><wicri:regionArea>Division of Infectious Diseases, HIV/AIDS Unit, Geneva University Hospitals</wicri:regionArea><wicri:noRegion>Geneva University Hospitals</wicri:noRegion></affiliation></author><author><name sortKey="Gayet Ageron, Angele" sort="Gayet Ageron, Angele" uniqKey="Gayet Ageron A" first="Angèle" last="Gayet-Ageron">Angèle Gayet-Ageron</name><affiliation wicri:level="1"><nlm:affiliation>CRC and Division of Clinical Epidemiology, Department of Health and Community Medicine, University of Geneva and University Hospitals of Geneva, Switzerland.</nlm:affiliation><country xml:lang="fr">Suisse</country><wicri:regionArea>CRC and Division of Clinical Epidemiology, Department of Health and Community Medicine, University of Geneva and University Hospitals of Geneva</wicri:regionArea><wicri:noRegion>University of Geneva and University Hospitals of Geneva</wicri:noRegion></affiliation></author><author><name sortKey="Gold, Gabriel" sort="Gold, Gabriel" uniqKey="Gold G" first="Gabriel" last="Gold">Gabriel Gold</name><affiliation wicri:level="1"><nlm:affiliation>Service of Geriatrics, Department of Internal Medicine Rehabilitation and Geriatrics, University Hospitals and University of Geneva, Switzerland.</nlm:affiliation><country xml:lang="fr">Suisse</country><wicri:regionArea>Service of Geriatrics, Department of Internal Medicine Rehabilitation and Geriatrics, University Hospitals and University of Geneva</wicri:regionArea><wicri:noRegion>University Hospitals and University of Geneva</wicri:noRegion></affiliation></author><author><name sortKey="Perrier, Arnaud" sort="Perrier, Arnaud" uniqKey="Perrier A" first="Arnaud" last="Perrier">Arnaud Perrier</name><affiliation wicri:level="1"><nlm:affiliation>Medical Directorate, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland / Department of General Internal Medicine, Geneva University Hospitals, Switzerland.</nlm:affiliation><country xml:lang="fr">Suisse</country><wicri:regionArea>Medical Directorate, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland / Department of General Internal Medicine, Geneva University Hospitals</wicri:regionArea><wicri:noRegion>Geneva University Hospitals</wicri:noRegion></affiliation></author><author><name sortKey="Picard, Fabienne" sort="Picard, Fabienne" uniqKey="Picard F" first="Fabienne" last="Picard">Fabienne Picard</name><affiliation wicri:level="1"><nlm:affiliation>Division of Neurology, Department of Clinical Neurosciences, University of Geneva and University Hospitals of Geneva, Switzerland.</nlm:affiliation><country xml:lang="fr">Suisse</country><wicri:regionArea>Division of Neurology, Department of Clinical Neurosciences, University of Geneva and University Hospitals of Geneva</wicri:regionArea><wicri:noRegion>University of Geneva and University Hospitals of Geneva</wicri:noRegion></affiliation></author><author><name sortKey="Prendki, Virginie" sort="Prendki, Virginie" uniqKey="Prendki V" first="Virginie" last="Prendki">Virginie Prendki</name><affiliation wicri:level="1"><nlm:affiliation>Division of Internal Medicine for the Aged, University of Geneva and University Hospitals of Geneva, Thônex, Switzerland.</nlm:affiliation><country xml:lang="fr">Suisse</country><wicri:regionArea>Division of Internal Medicine for the Aged, University of Geneva and University Hospitals of Geneva, Thônex</wicri:regionArea><wicri:noRegion>Thônex</wicri:noRegion></affiliation></author><author><name sortKey="Reny, Jean Luc" sort="Reny, Jean Luc" uniqKey="Reny J" first="Jean-Luc" last="Reny">Jean-Luc Reny</name><affiliation wicri:level="1"><nlm:affiliation>Department of General Internal Medicine, Geneva University Hospitals, Switzerland.</nlm:affiliation><country xml:lang="fr">Suisse</country><wicri:regionArea>Department of General Internal Medicine, Geneva University Hospitals</wicri:regionArea><wicri:noRegion>Geneva University Hospitals</wicri:noRegion></affiliation></author><author><name sortKey="Samer, Caroline" sort="Samer, Caroline" uniqKey="Samer C" first="Caroline" last="Samer">Caroline Samer</name><affiliation wicri:level="1"><nlm:affiliation>Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Switzerland.</nlm:affiliation><country xml:lang="fr">Suisse</country><wicri:regionArea>Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals</wicri:regionArea><wicri:noRegion>Geneva University Hospitals</wicri:noRegion></affiliation></author><author><name sortKey="Stirnemann, Jerome" sort="Stirnemann, Jerome" uniqKey="Stirnemann J" first="Jérôme" last="Stirnemann">Jérôme Stirnemann</name><affiliation wicri:level="1"><nlm:affiliation>Department of General Internal Medicine, Geneva University Hospitals, Switzerland.</nlm:affiliation><country xml:lang="fr">Suisse</country><wicri:regionArea>Department of General Internal Medicine, Geneva University Hospitals</wicri:regionArea><wicri:noRegion>Geneva University Hospitals</wicri:noRegion></affiliation></author><author><name sortKey="Vetter, Pauline" sort="Vetter, Pauline" uniqKey="Vetter P" first="Pauline" last="Vetter">Pauline Vetter</name><affiliation wicri:level="1"><nlm:affiliation>Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Switzerland.</nlm:affiliation><country xml:lang="fr">Suisse</country><wicri:regionArea>Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals</wicri:regionArea><wicri:noRegion>Geneva University Hospitals</wicri:noRegion></affiliation></author><author><name sortKey="Zanella, Marie Celine" sort="Zanella, Marie Celine" uniqKey="Zanella M" first="Marie-Céline" last="Zanella">Marie-Céline Zanella</name><affiliation wicri:level="1"><nlm:affiliation>Division of Infectious Diseases, Geneva University Hospitals, Switzerland.</nlm:affiliation><country xml:lang="fr">Suisse</country><wicri:regionArea>Division of Infectious Diseases, Geneva University Hospitals</wicri:regionArea><wicri:noRegion>Geneva University Hospitals</wicri:noRegion></affiliation></author><author><name sortKey="Zekry, Dina" sort="Zekry, Dina" uniqKey="Zekry D" first="Dina" last="Zekry">Dina Zekry</name><affiliation wicri:level="1"><nlm:affiliation>Division of Internal Medicine for the Aged, University of Geneva and University Hospitals of Geneva, Thônex, Switzerland.</nlm:affiliation><country xml:lang="fr">Suisse</country><wicri:regionArea>Division of Internal Medicine for the Aged, University of Geneva and University Hospitals of Geneva, Thônex</wicri:regionArea><wicri:noRegion>Thônex</wicri:noRegion></affiliation></author><author><name sortKey="Baggio, Stephanie" sort="Baggio, Stephanie" uniqKey="Baggio S" first="Stéphanie" last="Baggio">Stéphanie Baggio</name><affiliation wicri:level="1"><nlm:affiliation>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.</nlm:affiliation><country xml:lang="fr">Suisse</country><wicri:regionArea>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</wicri:regionArea><wicri:noRegion>Zurich</wicri:noRegion></affiliation></author></analytic><series><title level="j">Swiss medical weekly</title><idno type="eISSN">1424-3997</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adolescent (MeSH)</term><term>Adult (MeSH)</term><term>Age Factors (MeSH)</term><term>Aged (MeSH)</term><term>Aged, 80 and over (MeSH)</term><term>Antiviral Agents (administration & dosage)</term><term>Antiviral Agents (adverse effects)</term><term>Antiviral Agents (therapeutic use)</term><term>COVID-19 (drug therapy)</term><term>COVID-19 (epidemiology)</term><term>COVID-19 (mortality)</term><term>Child (MeSH)</term><term>Child, Preschool (MeSH)</term><term>Comorbidity (MeSH)</term><term>Drug Combinations (MeSH)</term><term>Drug Therapy, Combination (MeSH)</term><term>Health Expenditures (MeSH)</term><term>Hospital Mortality (trends)</term><term>Humans (MeSH)</term><term>Hydroxychloroquine (administration & dosage)</term><term>Hydroxychloroquine (adverse effects)</term><term>Hydroxychloroquine (therapeutic use)</term><term>Infant (MeSH)</term><term>Length of Stay (statistics & numerical data)</term><term>Lopinavir (administration & dosage)</term><term>Lopinavir (adverse effects)</term><term>Lopinavir (therapeutic use)</term><term>Middle Aged (MeSH)</term><term>Pandemics (MeSH)</term><term>Retrospective Studies (MeSH)</term><term>Ritonavir (administration & dosage)</term><term>Ritonavir (adverse effects)</term><term>Ritonavir (therapeutic use)</term><term>SARS-CoV-2 (MeSH)</term><term>Severity of Illness Index (MeSH)</term><term>Sex Factors (MeSH)</term><term>Socioeconomic Factors (MeSH)</term><term>Therapies, Investigational (methods)</term><term>Young Adult (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adolescent (MeSH)</term><term>Adulte (MeSH)</term><term>Adulte d'âge moyen (MeSH)</term><term>Antiviraux (administration et posologie)</term><term>Antiviraux (effets indésirables)</term><term>Antiviraux (usage thérapeutique)</term><term>Association de médicaments (MeSH)</term><term>Association médicamenteuse (MeSH)</term><term>Comorbidité (MeSH)</term><term>Durée du séjour (statistiques et données numériques)</term><term>Dépenses de santé (MeSH)</term><term>Enfant (MeSH)</term><term>Enfant d'âge préscolaire (MeSH)</term><term>Facteurs sexuels (MeSH)</term><term>Facteurs socioéconomiques (MeSH)</term><term>Facteurs âges (MeSH)</term><term>Humains (MeSH)</term><term>Hydroxychloroquine (administration et posologie)</term><term>Hydroxychloroquine (effets indésirables)</term><term>Hydroxychloroquine (usage thérapeutique)</term><term>Indice de gravité de la maladie (MeSH)</term><term>Jeune adulte (MeSH)</term><term>Lopinavir (administration et posologie)</term><term>Lopinavir (effets indésirables)</term><term>Lopinavir (usage thérapeutique)</term><term>Mortalité hospitalière (tendances)</term><term>Nourrisson (MeSH)</term><term>Pandémies (MeSH)</term><term>Ritonavir (administration et posologie)</term><term>Ritonavir (effets indésirables)</term><term>Ritonavir (usage thérapeutique)</term><term>Sujet âgé (MeSH)</term><term>Sujet âgé de 80 ans ou plus (MeSH)</term><term>Traitements en cours d'évaluation (méthodes)</term><term>Études rétrospectives (MeSH)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en"><term>Antiviral Agents</term><term>Hydroxychloroquine</term><term>Lopinavir</term><term>Ritonavir</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Antiviral Agents</term><term>Hydroxychloroquine</term><term>Lopinavir</term><term>Ritonavir</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Antiviral Agents</term><term>Hydroxychloroquine</term><term>Lopinavir</term><term>Ritonavir</term></keywords><keywords scheme="MESH" qualifier="administration et posologie" xml:lang="fr"><term>Antiviraux</term><term>Hydroxychloroquine</term><term>Lopinavir</term><term>Ritonavir</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>COVID-19</term></keywords><keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Antiviraux</term><term>Hydroxychloroquine</term><term>Lopinavir</term><term>Ritonavir</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>COVID-19</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Therapies, Investigational</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>COVID-19</term></keywords><keywords scheme="MESH" qualifier="méthodes" xml:lang="fr"><term>Traitements en cours d'évaluation</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Length of Stay</term></keywords><keywords scheme="MESH" qualifier="statistiques et données numériques" xml:lang="fr"><term>Durée du séjour</term></keywords><keywords scheme="MESH" qualifier="tendances" xml:lang="fr"><term>Mortalité hospitalière</term></keywords><keywords scheme="MESH" qualifier="trends" xml:lang="en"><term>Hospital Mortality</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Antiviraux</term><term>Hydroxychloroquine</term><term>Lopinavir</term><term>Ritonavir</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Age Factors</term><term>Aged</term><term>Aged, 80 and over</term><term>Child</term><term>Child, Preschool</term><term>Comorbidity</term><term>Drug Combinations</term><term>Drug Therapy, Combination</term><term>Health Expenditures</term><term>Humans</term><term>Infant</term><term>Middle Aged</term><term>Pandemics</term><term>Retrospective Studies</term><term>SARS-CoV-2</term><term>Severity of Illness Index</term><term>Sex Factors</term><term>Socioeconomic Factors</term><term>Young Adult</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adolescent</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Association de médicaments</term><term>Association médicamenteuse</term><term>Comorbidité</term><term>Dépenses de santé</term><term>Enfant</term><term>Enfant d'âge préscolaire</term><term>Facteurs sexuels</term><term>Facteurs socioéconomiques</term><term>Facteurs âges</term><term>Humains</term><term>Indice de gravité de la maladie</term><term>Jeune adulte</term><term>Nourrisson</term><term>Pandémies</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Études rétrospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>AIMS OF THE STUDY</b></p><p>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).</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>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.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>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).</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>Prescribing experimental therapies for COVID-19 was not associated with a reduced LOS and might have increased the pressure put on healthcare systems.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">33382449</PMID><DateCompleted><Year>2021</Year><Month>01</Month><Day>19</Day></DateCompleted><DateRevised><Year>2021</Year><Month>01</Month><Day>19</Day></DateRevised><Article PubModel="Electronic-eCollection"><Journal><ISSN IssnType="Electronic">1424-3997</ISSN><JournalIssue CitedMedium="Internet"><Volume>150</Volume><PubDate><Year>2020</Year><Month>12</Month><Day>14</Day></PubDate></JournalIssue><Title>Swiss medical weekly</Title><ISOAbbreviation>Swiss Med Wkly</ISOAbbreviation></Journal><ArticleTitle>Early experimental COVID-19 therapies: associations with length of hospital stay, mortality and related costs.</ArticleTitle><Pagination><MedlinePgn>w20446</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.4414/smw.2020.20446</ELocationID><ELocationID EIdType="pii" ValidYN="Y">Swiss Med Wkly. 2020;150:w20446</ELocationID><Abstract><AbstractText Label="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).</AbstractText><AbstractText Label="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.</AbstractText><AbstractText Label="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).</AbstractText><AbstractText Label="CONCLUSIONS">Prescribing experimental therapies for COVID-19 was not associated with a reduced LOS and might have increased the pressure put on healthcare systems.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Vernaz</LastName><ForeName>Nathalie</ForeName><Initials>N</Initials><AffiliationInfo><Affiliation>Medical Directorate, Finance Directorate, Geneva University Hospitals, Geneva University, Switzerland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Agoritsas</LastName><ForeName>Thomas</ForeName><Initials>T</Initials><AffiliationInfo><Affiliation>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.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Calmy</LastName><ForeName>Alexandra</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Division of Infectious Diseases, HIV/AIDS Unit, Geneva University Hospitals, Switzerland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Gayet-Ageron</LastName><ForeName>Angèle</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>CRC and Division of Clinical Epidemiology, Department of Health and Community Medicine, University of Geneva and University Hospitals of Geneva, Switzerland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Gold</LastName><ForeName>Gabriel</ForeName><Initials>G</Initials><AffiliationInfo><Affiliation>Service of Geriatrics, Department of Internal Medicine Rehabilitation and Geriatrics, University Hospitals and University of Geneva, Switzerland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Perrier</LastName><ForeName>Arnaud</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Medical Directorate, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland / Department of General Internal Medicine, Geneva University Hospitals, Switzerland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Picard</LastName><ForeName>Fabienne</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Division of Neurology, Department of Clinical Neurosciences, University of Geneva and University Hospitals of Geneva, Switzerland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Prendki</LastName><ForeName>Virginie</ForeName><Initials>V</Initials><AffiliationInfo><Affiliation>Division of Internal Medicine for the Aged, University of Geneva and University Hospitals of Geneva, Thônex, Switzerland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Reny</LastName><ForeName>Jean-Luc</ForeName><Initials>JL</Initials><AffiliationInfo><Affiliation>Department of General Internal Medicine, Geneva University Hospitals, Switzerland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Samer</LastName><ForeName>Caroline</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Switzerland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Stirnemann</LastName><ForeName>Jérôme</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Department of General Internal Medicine, Geneva University Hospitals, Switzerland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Vetter</LastName><ForeName>Pauline</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Switzerland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Zanella</LastName><ForeName>Marie-Céline</ForeName><Initials>MC</Initials><AffiliationInfo><Affiliation>Division of Infectious Diseases, Geneva University Hospitals, Switzerland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Zekry</LastName><ForeName>Dina</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>Division of Internal Medicine for the Aged, University of Geneva and University Hospitals of Geneva, Thônex, Switzerland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Baggio</LastName><ForeName>Stéphanie</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>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.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D064888">Observational Study</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>12</Month><Day>31</Day></ArticleDate></Article><MedlineJournalInfo><Country>Switzerland</Country><MedlineTA>Swiss Med Wkly</MedlineTA><NlmUniqueID>100970884</NlmUniqueID><ISSNLinking>0036-7672</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000998">Antiviral Agents</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D004338">Drug Combinations</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="C558899">lopinavir-ritonavir drug combination</NameOfSubstance></Chemical><Chemical><RegistryNumber>2494G1JF75</RegistryNumber><NameOfSubstance UI="D061466">Lopinavir</NameOfSubstance></Chemical><Chemical><RegistryNumber>4QWG6N8QKH</RegistryNumber><NameOfSubstance UI="D006886">Hydroxychloroquine</NameOfSubstance></Chemical><Chemical><RegistryNumber>O3J8G9O825</RegistryNumber><NameOfSubstance UI="D019438">Ritonavir</NameOfSubstance></Chemical></ChemicalList><SupplMeshList><SupplMeshName Type="Protocol" UI="C000705127">COVID-19 drug treatment</SupplMeshName></SupplMeshList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000293" MajorTopicYN="N">Adolescent</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000367" MajorTopicYN="N">Age Factors</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000369" MajorTopicYN="N">Aged, 80 and over</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000998" MajorTopicYN="N">Antiviral Agents</DescriptorName><QualifierName UI="Q000008" MajorTopicYN="N">administration & dosage</QualifierName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000086382" MajorTopicYN="N">COVID-19</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="Y">drug therapy</QualifierName><QualifierName UI="Q000453" MajorTopicYN="Y">epidemiology</QualifierName><QualifierName UI="Q000401" MajorTopicYN="N">mortality</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D002648" MajorTopicYN="N">Child</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D002675" MajorTopicYN="N">Child, Preschool</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D015897" MajorTopicYN="N">Comorbidity</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004338" MajorTopicYN="N">Drug Combinations</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004359" MajorTopicYN="N">Drug Therapy, Combination</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005102" MajorTopicYN="N">Health Expenditures</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017052" MajorTopicYN="N">Hospital Mortality</DescriptorName><QualifierName UI="Q000639" MajorTopicYN="N">trends</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006886" MajorTopicYN="N">Hydroxychloroquine</DescriptorName><QualifierName UI="Q000008" MajorTopicYN="N">administration & dosage</QualifierName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D007223" MajorTopicYN="N">Infant</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007902" MajorTopicYN="N">Length of Stay</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D061466" MajorTopicYN="N">Lopinavir</DescriptorName><QualifierName UI="Q000008" MajorTopicYN="N">administration & dosage</QualifierName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D058873" MajorTopicYN="N">Pandemics</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D019438" MajorTopicYN="N">Ritonavir</DescriptorName><QualifierName UI="Q000008" MajorTopicYN="N">administration & dosage</QualifierName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000086402" MajorTopicYN="N">SARS-CoV-2</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012720" MajorTopicYN="N">Severity of Illness Index</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012737" MajorTopicYN="N">Sex Factors</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012959" MajorTopicYN="N">Socioeconomic Factors</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D035703" MajorTopicYN="N">Therapies, Investigational</DescriptorName><QualifierName UI="Q000379" MajorTopicYN="N">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D055815" MajorTopicYN="N">Young Adult</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>12</Month><Day>31</Day><Hour>12</Hour><Minute>8</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2021</Year><Month>1</Month><Day>1</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2021</Year><Month>1</Month><Day>20</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>epublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">33382449</ArticleId><ArticleId IdType="doi">10.4414/smw.2020.20446</ArticleId><ArticleId IdType="pii">Swiss Med Wkly. 2020;150:w20446</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>Canada</li><li>Suisse</li></country></list><tree><country name="Suisse"><noRegion><name sortKey="Vernaz, Nathalie" sort="Vernaz, Nathalie" uniqKey="Vernaz N" first="Nathalie" last="Vernaz">Nathalie Vernaz</name></noRegion><name sortKey="Baggio, Stephanie" sort="Baggio, Stephanie" uniqKey="Baggio S" first="Stéphanie" last="Baggio">Stéphanie Baggio</name><name sortKey="Calmy, Alexandra" sort="Calmy, Alexandra" uniqKey="Calmy A" first="Alexandra" last="Calmy">Alexandra Calmy</name><name sortKey="Gayet Ageron, Angele" sort="Gayet Ageron, Angele" uniqKey="Gayet Ageron A" first="Angèle" last="Gayet-Ageron">Angèle Gayet-Ageron</name><name sortKey="Gold, Gabriel" sort="Gold, Gabriel" uniqKey="Gold G" first="Gabriel" last="Gold">Gabriel Gold</name><name sortKey="Perrier, Arnaud" sort="Perrier, Arnaud" uniqKey="Perrier A" first="Arnaud" last="Perrier">Arnaud Perrier</name><name sortKey="Picard, Fabienne" sort="Picard, Fabienne" uniqKey="Picard F" first="Fabienne" last="Picard">Fabienne Picard</name><name sortKey="Prendki, Virginie" sort="Prendki, Virginie" uniqKey="Prendki V" first="Virginie" last="Prendki">Virginie Prendki</name><name sortKey="Reny, Jean Luc" sort="Reny, Jean Luc" uniqKey="Reny J" first="Jean-Luc" last="Reny">Jean-Luc Reny</name><name sortKey="Samer, Caroline" sort="Samer, Caroline" uniqKey="Samer C" first="Caroline" last="Samer">Caroline Samer</name><name sortKey="Stirnemann, Jerome" sort="Stirnemann, Jerome" uniqKey="Stirnemann J" first="Jérôme" last="Stirnemann">Jérôme Stirnemann</name><name sortKey="Vetter, Pauline" sort="Vetter, Pauline" uniqKey="Vetter P" first="Pauline" last="Vetter">Pauline Vetter</name><name sortKey="Zanella, Marie Celine" sort="Zanella, Marie Celine" uniqKey="Zanella M" first="Marie-Céline" last="Zanella">Marie-Céline Zanella</name><name sortKey="Zekry, Dina" sort="Zekry, Dina" uniqKey="Zekry D" first="Dina" last="Zekry">Dina Zekry</name></country><country name="Canada"><noRegion><name sortKey="Agoritsas, Thomas" sort="Agoritsas, Thomas" uniqKey="Agoritsas T" first="Thomas" last="Agoritsas">Thomas 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