Healthcare Costs and Disease Duration Associated with Mild, Moderate and Severe COVID-19: A Payer Perspective

Background: Acute coronavirus disease 2019 (COVID-19) clinical presentation ranges from asymptomatic to deadly.

Objectives: Our study analyzed how risk factors, duration of disease, and US-payer payments for COVID-19 differ by disease severity.

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. Asymptomatic patients (no diagnoses for COVID-19 signs or symptoms) were excluded. Variables included demographics, comorbidities (Elixhauser index (EI) and all 31 Elixhauser disease domains), and COVID-19 signs and symptoms. 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. Outcomes were all-cause and disease-specific payments (payments associated specifically with diagnoses of signs or symptoms of respiratory disease and prescriptions associated with COVID-19) for the entire disease duration, or duration of available follow-up, for patients with ongoing disease. Adjusted incremental payments from mild to moderate and SC cohorts were estimated using a generalized linear model with gamma distribution and log link. Risk factors for increased payment and duration of disease were analyzed by disease severity using logistic regression.

Results: 383,883 patients [160,326 mild cases with 55% female, EI: 0.68 (standard deviation (SD): 1.15) age: 37.7 (SD: 17.1); 189,240 moderate cases with 57% female, EI: 1.04 (SD: 1.49), age: 42.7 (SD: 16.5); 34,317 SC cases with 44% female, EI: 2.16 (SD: 2.35), age: 55.6 (SD: 14.9)] were included. Increasing rates for all 31 comorbidities were observed from mild, moderate to SC cohorts. Entire duration of disease increased from 18.8 (SD: 15.3) for mild patients to 60.7 (SD: 67.0) days for SC patients. A duration of disease exceeding 12 weeks was observed for 0.6% mild, 3.6% moderate and 19.5% severe cases. Commercial disease-specific adjusted payments increased from $427 (95% confidence interval (CI):$419-$435) for mild to $27,335 (95%CI:$26,140-$28,530) for SC cases (incremental payments from mild to moderate and mild to SC: $1,359 (95%CI:$1,328-$1,390) and $26,908 (95%CI:$25,712-$28,103), respectively). Adjusted incremental duration from mild to SC was 33.7 days (95%CI: 33.1-34.3).

Conclusions: Patients with SC COVID-19 had significantly increased cost and disease duration compared to mild cases.