Outcomes related to health status and economic burden among patients who experienced critical COVID-19 remain insufficiently studied. We examined 180-day post-discharge mortality and total medical expenditures in COVID-19 patients according to their use of mechanical ventilation (MV) or extracorporeal membrane oxygenation (ECMO) during hospitalization. Using medical claims data from a Japanese municipality, this retrospective cohort study analyzed hospitalized COVID-19 patients who were discharged between April 1, 2020 and September 30, 2021. Patients were categorized into an MV/ECMO group (indicating severe disease) or a non-MV/ECMO group. Their differences in mortality and expenditures were compared using the χ 2 test and Mann–Whitney U test, respectively. A Cox regression analysis was performed to calculate the hazard ratios of MV/ECMO use for mortality, and a generalized linear model with gamma distribution was constructed to examine the association between MV/ECMO use and expenditures. The covariates included age, sex, comorbidities, and length of stay. The MV/ECMO group had significantly higher mortality (16. 0% vs. 11. 1%, p = 0. 002) and expenditures (8, 732 vs. 3, 460, p < 0. 001) than the non-MV/ECMO group. MV/ECMO use was significantly associated with higher mortality (hazard ratio: 1. 66, 95% confidence interval: 1. 27–2. 15) ; other risk factors included age (1. 06, 1. 05–1. 07), dementia (1. 48, 1. 10–1. 99), and cancer (1. 92, 1. 56–2. 36). MV/ECMO use was also significantly associated with higher expenditures (Expβ: 1. 49, 95% confidence interval: 1. 29–1. 73) ; other risk factors included kidney disease (1. 60, 1. 29–2. 01), cerebrovascular disease (1. 74, 1. 56–1. 94), and cancer (1. 28, 1. 14–1. 44). Survivors of severe COVID-19 who required MV or ECMO during hospitalization were associated with higher post-discharge mortality and expenditures, suggesting a need for targeted care to reduce their clinical and economic burden.
Kawabata et al. (Thu,) studied this question.