Abstract: Background and objective: COVID-19 vaccination may alter the course of severe disease and influence hospital discharge costs. This study compares hospital discharge costs among ICU-admitted COVID-19 patients based on vaccination status, adjusted for All Patient Refined Diagnosis Related Groups (APR-DRG) and severity. Patients and methods: A retrospective study (March 2020-March 2022) was conducted in an ICU, categorizing patients into three groups: unvaccinated, fully vaccinated, and partially vaccinated. Full vaccination included all required doses and boosters per the vaccination schedule. Disease severity was classified as mild, moderate, severe, and critical. Direct hospital costs, including ICU stay, medical procedures, medications, and life support, were analysed using data from Order SAN/35/2017, adjusted for inflation. Chi-square and Kruskal-Wallis tests with Bonferroni correction were used for comparisons. Results: A total of 456 patients were included: 262 (57%) unvaccinated, 32 (7%) partially vaccinated, and 162 (35%) fully vaccinated. Median costs were: Unvaccinated: €10,653 (IQR: €6160-€18,274) Partially vaccinated: €17,360 (IQR: €5061-€26,085) Fully vaccinated: €10,653 (IQR: €6160-€26,085) Cost differences were not statistically significant (p = 0.28). Critical severity patients had the highest costs, while mild cases had the lowest (p < 0.05). No significant cost differences were found within each severity level or in APR-DRG relative weight (p = 0.38). Conclusions: No significant differences in hospital discharge costs by APR-DRG were found based on vaccination status. However, vaccination may reduce disease severity and the need for intensive resources, with potential economic and clinical implications for future research.

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