Risk factors, health outcomes, healthcare services utilization, and direct medical costs of patients with long COVID

OBJECTIVES: Data on the economic burden of long COVID are scarce. We aimed to examine the prevalence and medical costs of treating long COVID. METHODS: We conducted this historical cohort study using data from patients with COVID-19 among members of a large health provider in Israel. Cases were defined according to physician diagnosis (definite long COVID) or suggestive symptoms given ≥ 4 weeks from infection (probable cases). Healthcare resource utilization and direct healthcare costs (HCCs) in the period before infection and afterward were compared across study groups. RESULTS: Between March 2020, and March 2021, a total of 180, 759 COVID-19 patients (mean SD age = 32. 9 years 19. 0 years; 89, 665 49. 6% females) were identified. Overall, 14, 088 (7. 8%) individuals developed long COVID (mean SD age = 40. 0 years 19. 0 years; 52. 4% females). Among them, 1477 (10. 5%) were definite long COVID and 12, 611 (89. 5%) were defined as probable long COVID. Long COVID was associated with age (adjusted odds ratio AOR = 1. 058 per year, 95% CI: 1. 053-1. 063), female sex (AOR = 1. 138; 95% CI: 1. 098-1. 180), smoking (AOR = 1. 532; 95% CI: 1. 358-1. 727), and symptomatic acute phase (AOR = 1. 178; 95% CI: 1. 133-1. 224), primarily muscle pain and cough. Hypertension was an important risk factor for long COVID among younger adults. Compared with patients with non-long COVID, definite and probable cases were associated with AORs of 2. 47 (2. 22-2. 75) and 1. 76 (1. 68-1. 84) for post-COVID hospitalization, respectively. Although among patients with non-long COVID HCCs decreased from 1400 during 4 months before the infection to 1021 and among patients with long COVID, HCCs increased from 2435 to 2810. CONCLUSION: Long COVID is associated with a substantial increase in the utilization of healthcare services and direct medical costs. Our findings underline the need for timely planning and allocating resources for patient-centered care for patients with long COVID as well as for its secondary prevention in high-risk patients.