Economic Burden of Post-COVID Syndrome in Germany Between 2021 and 2025: A Statutory Health Insurance Claims Data Analysis

Background Evidence on the economic burden of post-COVID syndrome in Germany remains limited. This study quantifies post-COVID-associated healthcare resource utilization (HCRU), sick leave, and costs. Objectives To compare HCRU, sick leave, and costs borne by the statutory health insurance (SHI) among incident pediatric and adult post-COVID patients with matched post-COVID-free controls. Methods This retrospective cohort study analyzed an anonymized German SHI claims database provided by GWQ ServicePlus AG. The observation period spanned October 2021 to June 2025 and included all individuals with incident COVID-19 diagnosis until September 2024. Incident post-COVID was defined as the first ICD-10-GM code (U07.4!; U09.9!) recorded ≥90 days after first COVID-19 diagnosis. Post-COVID cases were exactly matched 1:2 to post-COVID–free COVID-19 controls by calendar quarter of incident COVID-19 diagnosis, acute severity, cohort entry quarter, 5-year birth interval, sex, and Elixhauser Comorbidity Index. We estimated mean differences in HCRU, sick leave, and direct SHI-borne costs per case. Rate ratios of HCRU, sick leave, and costs per person-year were estimated using Poisson (HCRU/sick leave) and linear (costs) regression. Analyses covered 365-day, 730-day, and any follow-up period. Results We matched 25 485 identified post-COVID cases with 49 671 controls. Matched cases and controls were comparable in age, sex, and comorbidities. Overall, during 365 days of follow-up, post-COVID patients showed higher HCRU and sick leave rates across all sectors, especially sick leave days. Mean differences per case were greatest for sick leave days (365 days: +27 days) and outpatient physician contacts (365 days: 6.9 contacts). HCRU and sick leave rates remained significantly increased over extended follow-up periods. Total SHI-borne costs per person-year were higher among post-COVID patients across all follow-up periods (all P < .001). Sector-specific costs per person-year were increased primarily in the outpatient sector and for sickness benefits (all P < .001). Mean total cost differences per case were +€1806 per case (365 days) and mean excess sickness benefits per case were +€1077. Conclusions Documented post-COVID was associated with a substantial and sustained economic burden on the German healthcare system and society. Targeted strategies are needed to mitigate potential long-term impacts on HCRU and labor productivity.