(235) Healthcare Costs of COVID-19 Versus Flu and Pneumonia – A Payer Perspective

Publication Number: 909

Background: Payer costs associated with the acute coronavirus 2019 disease (COVID-19) vs other respiratory diseases are not well documented.

Objectives: Our study evaluates the payer costs of patients with COVID-19 compared to those of patients with influenza and viral pneumonia.

Methods: Patients with COVID-19 from October 1st, 2020, to February 1st, 2021, or with influenza/ pneumonia (IP) from October 1st, 2018 to February 1st, 2019 were identified in IBM® MarketScan® Commercial Claims and Encounters (CCAE) and Medicare Supplemental databases. The date of first COVID-19 or influenza/pneumonia (IP) diagnosis was defined as “index”; all patients had ≥ 6 months of continuous enrollment pre- and post-index. COVID-19 patients were categorized by disease severity (mild, moderate, and severe) using the signs and symptoms definitions from the Janssen Phase 3 Trial. Asymptomatic COVID-19 cases were excluded. Variables for all patients included demographics and comorbidities at index. Duration of disease was estimated for all patients based on the date of first and last associated diagnosis or prescription. A maximum 35-day visit gap was allowed. Outcomes were all-cause payments (ACP) and disease-specific payments (DSP) for the entire disease duration. IP and COVID-19 cohorts were matched 1:1 on age, sex, and comorbidities (R package MatchIt, distance: GLM, method: nearest, caliper:0.1). Inflation-adjusted payments to 2021 consumer-price index for IP vs COVID-19, and IP vs each severity of COVID-19, were estimated using generalized linear models with gamma distribution and log link.

Results:

Results: Matched cohorts included 6,332 Medicare [58.5% female, average age 75.3 (standard deviation (SD): 7.6), and 397,532 commercially-insured patients [57.6% female, average age 34.7 (SD: 16.7)] . Payments, both Commercial and Medicare, were significantly greater for COVID-19 patients than flu/pneumonia patients [Commercial ACP: COVID-19: $5,060 (95%CI:$4,923 - $5,197), IP: $ 3,162 (95%CI: $3,039 - $3,285), p < 0.001]. When comparing IP to COVID-19 severity categories, adjusted incremental payments between IP and severe COVID-19 averaged $24,853 (95% CI $21,574 - $28,132) for DSP and $50,326 (95% CI $43,932 - $56,719) for ACP, respectively (p < 0.01). IP was also significantly less expensive than moderate COVID-19 for Commercial payers (but not for Medicare). IP was more expensive than mild COVID-19.

Conclusions: The cost of care for severe COVID-19 patients significantly exceeded that for patients with influenza/pneumonia matched on age and comorbidities, for both Medicare and Commercial payers.