(212) Understanding The Impact of the COVID-19 Pandemic on Disease Burden Among Patients with Employer Sponsored Insurance in the United States: An Analysis of Alterations in Healthcare Resource Utilization
Background: The COVID-19 pandemic has changed patient care due to the accessibility of healthcare services and patient willingness to seek out care.
Objectives: This study examined quarterly healthcare resource utilization patterns for patients with pregnancy, type 2 diabetes (T2D), breast cancer (BC) and colorectal cancer (CRC) in 2018 and 2020 to investigate disease management trends during the pandemic and their potential impact on long-term disease burden.
Methods: Calendar year based cohorts of adults diagnosed with pregnancy, T2D, BC, or CRC in 2018 or 2020 were established. Patients had to be continuously enrolled in the MarketScan Commercial and Medicare database for the calendar year of interest and 6 months prior. Changes in quarterly healthcare resource utilization, relative to Q1 of the calendar year, were assessed in the 2018 (control) and 2020 (COVID-19) cohorts to examine the impact of the COVID-19 pandemic on disease management.
Results: Differential patterns of service use were observed between 2018 and 2020. Coincident with the emergence of the COVID-19 pandemic, sharp reductions in the proportion of patients with 1 emergency room (ER) (-24% to -34%) or office visit (-17% to -33%) were observed in Q2 2020 for all four conditions. The cancer cohorts saw the greatest Q2 reduction in the proportion of patients with 1 inpatient (IP) admission (-18% in CRC and -30% in BC). However, Q2 reductions in office, ER, and IP service use were short-lived for cancer patients, rebounding past Q1 levels in all sites of care by Q4. T2D patients had a smaller reduction in Q2 IP admissions (-12%); however, their reductions in ER and office visits lingered into Q3/Q4. Rates of 2020 IP admissions were largely static for pregnant patients, with ~10% of women with 1 IP admission/quarter. Pregnant women also had the smallest reduction in Q2 office visits (-17%) with rates reverting to Q1 levels by Q4. Conversely, ER visits remained low from Q2 (-30%) through Q4 (-13%) within the pregnant sample.
Conclusions: COVID-19 has disrupted the US healthcare system. Differential trends in service use observed across the 4 conditions assessed here likely emanate from perceived differences, potentially patient or provider initiated, in the risk versus benefit of seeking care in the face of a global pandemic. It remains to be seen how pandemic-related reductions in care will impact the longer-term burdens of disease in the US as rebounds in care may not be adequate to pandemic related disruptions.
