(236) Cost of Long COVID-19 Following Severe Disease – A Healthcare Database Analysis

Publication Number: 910

Background: Post-acute signs and symptoms of COVID-19 are defined as ongoing symptomatic COVID-19 (OSC), experienced from 4 to 12 weeks post-infection, and post-COVID-19 syndrome (PCS), after 12 weeks from infection.

Objectives: Our study evaluated payer costs and risk factors for OSC and PCS within patients with a severe or critical COVID-19 at the time of acute disease.

Methods:

Methods: Patients with COVID-19 (first date = index) from April 1, 2020, to February 1, 2021, and ≥ 6 months of continuous enrollment pre- and post-index, in IBM® MarketScan® Commercial and Medicare Supplemental databases, were identified and stratified by severity of disease, during the disease's acute phase, using the mild, moderate and severe/critical (SC) disease signs and symptoms as defined by the Janssen vaccine Phase 3 Trial. Only patients with SC disease were included in this analysis. Variables included demographics, comorbidities (Elixhauser index (EI) and all 31 Elixhauser disease domains), and COVID-19 signs and symptoms at the time of acute disease. Disease duration was defined as follows: from 5 days before a positive test date to 9 days post last visit date with a COVID-19 sign/symptom diagnosis, with a maximum gap between visit/prescriptions of 35 days. For ongoing disease: patients were categorized as having no post-acute symptoms (NPAS), OSC, or PCS based on disease duration < 4 weeks, 4-12 weeks, and > 12 weeks, respectively. All-cause payments (ACP) and disease-specific payments (DSP) for patients with NPAS, OSC, and PCS were estimated from index to end of disease duration or last available date (for ongoing, unresolved disease), using generalized linear models with gamma distribution and log link.

Results: 34,317 severe patients were included [age: 55.6 (standard deviation (SD): 14.9, 44% female, EI: 2.16 (SD: 2.35)], 39.1% NPAS, 41.4% OSC and 19.5% PCS. Disease duration for SC patients with NPAS, OSC and PCS averaged 19.5 (SD 3.6), 49.3 (SD15.6) and 167.6 days (SD: 85.6), respectively. 4% patients had ongoing disease, with mean duration 279 days (SD: 82.7). Adjusted commercial DSP for SC patients with NPAS, OSC and PCS averaged $17,333 (95%CI:$16,485-$18,181), $27,043 (95%CI:$25,711-$28,376) and $68,069 (95%CI:$62,739-$73,400), respectively. The adjusted incremental payments from NPAS to OSC and PCS reached $9,711 (95%CI:$8,133-$11,288) and $50,736 (95%CI:$45,337-$56,136), respectively. Adjusted commercial ACP averaged $31,255 (95%CI:$30,205-$32,305), $49,866 (95%CI:$48,181-$51,550) and $126,094 (95%CI:$119,373-$132,814) for NPAS, OSC and PCS (incremental ACP from NPAS to PCS: $94,839 (95%CI:$88,029-$101,649)).

Conclusions: PCS affects 1 in 5 severe COVID-19 patients and increases disease-specific healthcare payments by more than $50K per patient.