Director of Research Panalgo Boston, United States
Background: The symptoms of patients with post-acute COVID-19 syndrome (i.e., long COVID) are heterogenous, impact multiple systems, and are often non-specific. Limited data exist that compare patients with long COVID to a COVID-19 control group.
Objectives: To compare the baseline clinical characteristics, resource use, and monthly costs of patients diagnosed with long COVID relative to those that do not receive the diagnosis.
Methods: Children/adolescents (age 0-17) and adults (age 18-39, 40-64 and ≥65) with ≥2 primary diagnoses for U09.9 “Post COVID-19 condition” from 10/01/2021 (ICD-10 code introduction) until 06/30/2022 were selected from Optum’s de-identified Clinformatics® Data Mart Database. Included patients had ≥1 diagnosis for COVID-19 (first deemed index), continuous enrollment during the 12 months prior to index (baseline) with no evidence of prior COVID-19 infection. Patients had continuous enrollment during the six months following index and no evidence of death during the study period. COVID-19 controls with no evidence of long COVID were matched 1:1 to cases based on age, sex, and COVID-19 infection date. Baseline comorbidities and resource use, as well as monthly medical costs during the six months prior to index, the month of index, and six months post index were evaluated.
Results: 910 patients with a long COVID diagnosis met full inclusion criteria and were matched for analysis. The average time to long COVID diagnosis following index was 115 (± 91) days. A higher proportion of long COVID patients had an ER visit (24% vs. 22%, P< 0.01) while a higher proportion of controls experienced an inpatient hospitalization during baseline (8% vs. 6%, P< 0.01). Baseline comorbidities with ≥3% difference (all P< 0.01) included overweight/obesity (27.28% long COVID vs. 22.54% control), pre-existing malaise/fatigue (24.08% vs. 18.74%), gastroesophageal reflux disease (23.13% vs. 18.39%), pain (19.10% vs. 15.78%) and depression (19.81% vs. 15.54%). Average medical costs during the six months prior to COVID diagnosis did not differ ($6,737 long COVID vs. $6,379 control, P=0.70), however, costs associated with the month of index were significantly higher among the long COVID cohort ($50,554 vs. $7,504, P < 0.01) due to a higher hospitalization rate during the initial COVID-19 infection (25% vs. 9%). Costs tended to converge during follow up, with a modest difference between groups by the sixth month post index ($1,929 long COVID vs. $1,315 control, P=0.09).
Conclusions: Based on early experience with a long COVID billing code, patients with long COVID were more likely to be hospitalized than controls. However, their excess medical costs were relatively modest by six months.
