Impact of COVID-19 on ICU costs in a public university hospital: comparison between Absorption Costing and TDABC

ICU costs in COVID-19: Absorption vs TDABC

Authors

  • Filipe Carrilho de Aguiar Hospital das Clínicas da Universidade Federal de Pernambuco, Empresa Brasileira de Serviços Hospitalares, Recife, Pernambuco, Brasil. https://orcid.org/0000-0002-8277-2631
  • Umbelina Cravo Teixeira Lagioia UFPE https://orcid.org/0000-0001-8422-7808
  • Rodrigo Vicente dos Prazeres UFAL https://orcid.org/0000-0002-9888-1330
  • Juliana Gonçalves de Araújo Universidade de Pernambuco, Recife, Pernambuco, Brasil.
  • Ubiracé Fernando Elihimas Júnior UFPE
  • Adriana Falangola Benjamin Bezerra Centro de Ciências Médicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brasil. https://orcid.org/0000-0002-5278-3727

Keywords:

Costs and Cost Analysis; Intensive Care Units; COVID-19; Hospital Administration; Health Economics.

Abstract

Objective: To evaluate the impact of COVID-19 on ICU admission costs in a public university hospital, comparing absorption costing and Time-Driven Activity-Based Costing (TDABC). Methods: A longitudinal study was conducted in a tertiary hospital in Brazil, involving 269 admissions (2019: n=187, non-COVID-19; 2020: n=82, COVID-19). Absorption costs were estimated for both years, while TDABC was applied to a subsample of 48 COVID-19 cases. Costs were analyzed by length of stay (1–5; 5–10; 11–15; 15–20; >20 days). Results: There was a significant increase in average costs in 2020, especially in the 1–5 days (+69.7%) and 5–10 days (+83.6%) strata compared to 2019. Absorption costing overestimated values compared to TDABC, with differences ranging from 4.0% to 84.3%. All groups showed a deficit compared to SUS (Unified Health System) reimbursements, concentrated within the first 15 days of hospitalization. Conclusion: The pandemic substantially increased ICU costs, particularly at the beginning of admissions. TDABC showed higher accuracy in resource measurement and evidenced persistent underfunding, providing support for hospital management and the revision of SUS financing policies.

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Author Biographies

Umbelina Cravo Teixeira Lagioia, UFPE

Holds bachelor’s and master’s degrees in Accounting from the Federal University of Pernambuco, as well as PhDs in Administration (Finance) and Accounting from the same institution. She is a professor at the University of Pernambuco and a permanent faculty member of the Master’s Program in Management of Sustainable Local Development, with expertise in accounting, finance, and public management.

Rodrigo Vicente dos Prazeres , UFAL

Holds a bachelor’s degree in Accounting from the Catholic University of Pernambuco (2009) and master’s (2014) and doctoral (2019) degrees in Accounting from the Federal University of Pernambuco. He is currently an associate professor at the Faculty of Administration, Economics and Accounting of the Federal University of Alagoas (FEAC-UFAL), where he leads the Accounting and Behavior Studies Center (NECC-UFAL) and is a member of the Accounting Systems Research Center (NESC-UFAL) and the Research Group on Accounting Convergence and Capital Markets (UFPE). He has teaching experience at undergraduate and graduate levels (lato sensu and stricto sensu) in accounting, finance, and behavioral economics. His research interests include financial reporting for external users, with emphasis on accounting standards, corporate finance, and behavioral economics.

Juliana Gonçalves de Araújo, Universidade de Pernambuco, Recife, Pernambuco, Brasil.

Holds a bachelor’s degree (2013) and a master’s degree (2015) in Accounting, as well as a PhD in Administration – Finance (2017) and a PhD in Accounting (2023) from the Federal University of Pernambuco. During her undergraduate studies, she served as a teaching assistant and worked as both a volunteer and scholarship research assistant (PIBIC). She completed an internship at the Court of Justice of Pernambuco in the liquidation department and participated in research and intervention projects at Compesa and CEPE under the supervision of Professor Umbelina Lagioia, contributing to accounting convergence procedures in these entities. She has experience in teaching, course coordination, and the organization of academic events and extension activities. She is currently a professor at the University of Pernambuco and a permanent faculty member of the Master’s Program in Management of Sustainable Local Development.

Ubiracé Fernando Elihimas Júnior , UFPE

Physician graduated from the University of Pernambuco, with specialization in Internal Medicine and Nephrology. He holds a Master’s degree in Health Sciences from the Federal University of Pernambuco and a PhD in Health Sciences from the University of Pernambuco, with research focused on kidney disease progression and applications of artificial intelligence and machine learning in medicine.

Adriana Falangola Benjamin Bezerra, Centro de Ciências Médicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brasil.

Full Professor at the Center for Medical Sciences of the Federal University of Pernambuco, in the field of Collective Health. Her work focuses on public health, with emphasis on health policy, health planning and management, health economics, and health evaluation. She leads the Political Economy of Health Research Group (CNPq/UFPE) and is a member of the Health Economics Network (ECOS Network/Ministry of Health). She holds a PhD in Nutrition, with a concentration in Public Health.

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Published

2026-07-24

How to Cite

1.
de Aguiar FC, Lagioia UCT, dos Prazeres RV, de Araújo JG, Júnior UFE, Bezerra AFB. Impact of COVID-19 on ICU costs in a public university hospital: comparison between Absorption Costing and TDABC: ICU costs in COVID-19: Absorption vs TDABC. HU Rev [Internet]. 2026Jul.24 [cited 2026Jul.26];51:1-8. Available from: https://periodicos.ufjf.br/index.php/hurevista/article/view/52070

Issue

Vol. 51 (2025)

Section

Artigos Originais

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Copyright (c) 2026 Filipe Carrilho de Aguiar, Umbelina Cravo Teixeira Lagioia , Rodrigo Vicente dos Prazeres , Juliana Gonçalves de Araújo, Ubiracé Fernando Elihimas Júnior , Adriana Falangola Benjamin Bezerra

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