In a recent study posted to the SSRN* preprint server, researchers evaluated healthcare utilization by long coronavirus disease (COVID) or LC patients between January 2020 and 2023.
Study: Healthcare Utilisation of 282,080 Individuals with Long COVID Over Two Years: A Multiple Matched Control Cohort Analysis. Image Credit: Cryptographer/Shutterstock.com
*Important notice: SSRN publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
Background
LC is characterized by the presence of COVID-2019 (COVID-19) symptoms beyond four weeks of acute infection.
In the United Kingdom (UK) alone, LC has impacted millions of individuals; however, the LC burden on healthcare systems has not been extensively investigated. Improving our understanding of healthcare utilization could inform LC-related clinical care, service provision, and policy development.
About the study
In the present population-based study, researchers examined the scale and cost of healthcare utilization by long COVID patients in the UK.
The team used the National Health Service (NHS) England/British Heart Foundation (BHF) Secure Data Environment (SDE) to access the electronic medical records of adult CVD-COVIDUK/COVID-IMPACT study participants who received LC diagnoses between January of 2020, and the same month in 2023.
Individuals were matched for age, ethnicity, sex, region, comorbidities, and deprivation to form the following groups of controls:
- COVID-19 only, no long COVID (individuals who developed COVID-19 but not LC);
- (ii) pre-pandemic (before December 31, 2019, including individuals unimpacted by COVID-19-related health disruptions);
- (iii) non-COVID-19 contemporaries [individuals with no severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive reports in Second Generation Surveillance System (SGSS), no diagnosis codes and no primary-level care LC codes among individuals with no prior COVID-19 history through April 1, 2022]; and
- (iv) the pre-long COVID group (pre-COVID-19 information for those who developed LC).
Healthcare utilization (the number of healthcare visits/consultations per individual: primary-level (GP) care, secondary-level care [inpatient (IP), outpatient (OP), and emergency care department (ED)] and inflation-controlled expenses (£) were calculated for long COVID and controls every month, pandemic year, and calendar year for all categories.
LC phenotypes were identified using SNOMED-CT data and the international classification of diseases, tenth revision (ICD-10) codes for primary and secondary care data, respectively, including Hospital Episode Statics (HES) OP and Admitted Patient Care (APC), Emergency Care Data Set (ECDS), and the COVID General Practice Extraction Service Data for Pandemic Planning and Research (GDPPR).
Results
In total, 282,080 long COVID patients (median age of 48 years; 62% female) were included in the study. The controls included COVID-19-only, no-long COVID individuals (1,112,370 individuals), pre-pandemic (1,031,285 individuals), non-COVID-19 contemporaries (1,118,360 individuals), and pre-long COVID (282,080 individuals).
Healthcare utilization by each individual (each month per year) was greater among long COVID patients compared to GP and outpatient controls.
For ED and IP, long COVID patients showed higher healthcare utilization than controls except for the COVID-19-only, no-long COVID group. Non-COVID contemporaries utilized healthcare resources the least. Healthcare utilization by long COVID patients increased progressively from 2020 to 2023 compared to controls.
Annually, long COVID patients visited the GP more frequently (mean difference of 13 per individual per year) and had more outpatient visits (3.3 per individual per year) in comparison to controls, second to the COVID-19-only, no-long COVID group for inpatient and ED visits (0.9 and 0.8 per individual annually, respectively).
The lengths of inpatient visits and hospitalizations in the critical care department were the highest among COVID-19-only and no-long COVID (mean values of 5.4 days and 0.6 days, respectively).
The controls in the pre-long COVID and pre-COVID-19 groups showed similar healthcare utilization rates, although lower than non-COVID-19 contemporaries.
The mean cost per long COVID patient per year was significantly higher in the long COVID group (£3,350) compared to controls: pre-COVID-19: £1,210 (mean excess expense: -£2,235), COVID-19-only, no-long COVID: £1,283, and pre-long COVID: £870, except for the COVID-19 and no-long COVID: £5,961.
Almost all long COVID patients used primary care post-diagnosis; of those, 47% were for GP visits, 36% for laboratory investigations, and 18% for prescriptions. Among long COVID patients, 57% had OP appointments post-diagnosis, of which 30%, 41%, 3.8%, and 25% were referred from non-ED, GP, ED, and other departments, respectively.
In the long COVID group, 29% were admitted (all-cause) post-diagnosis, of which 53% were elective, 42% were emergency, and 1.6% were deceased. GP visits, outpatient appointments, hospitalizations, and ED visits by LC patients over time were highest in the two months post-LC diagnosis. Although reduced, there was sustained healthcare utilization over the following two years.
COVID-19-only, no-long COVID controls had the highest mortality at one and two years (2.7% and 3.2%, respectively).
Compared to long COVID patients (odds,1.0), GP visit odds were lower among all controls (pre-long COVID, 0.03; pre-COVID-19, 0.02; and COVID-19-only, no-long COVID, 0.1).
Concerning secondary-level care, compared to long COVID patients, non-COVID contemporaries had lower chances of outpatient, inpatient, critical care, and emergency department visits with corresponding odds of 0.7, 0.9, 0.9, and 0.9, respectively).
The corresponding odds for COVID-19-only, no-long COVID group were 0.7, 0.8, 1.3, and 0.9, respectively, and for pre-COVID-19 controls were 1.0, 1.2, 1.3, and 0.6, respectively. Pre-long COVID controls’ odds for ED, OP, and IP visits were 0.7, 1.1, and 1.1, respectively.
Compared to 2022, among long COVID patients, in 2023, GP, OP, IP, and ED visits were higher compared to COVID-19-only, no-long COVID controls in 2022 (9.0 vs. 8.0), 2021 (0.8 vs. 0.7), 2021 (0.2 vs. 0.2). Non-COVID-19 contemporaries had higher healthcare utilization than other controls in the years 2020 and 2021 but reduced it in 2022.
Conclusion
Based on the study findings, LC has significantly increased healthcare utilization and cost, necessitating future focus on reducing primary and secondary care provision.
Proper consideration of the long-term complications of LC and pandemic preparedness is crucial to reducing healthcare utilization and costs.
*Important notice: SSRN publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
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