Economic Burden of Post-COVID Syndrome in Germany Between 2021 and 2025: A Statutory Health Insurance Claims Data Analysis, 2026, Gensorowsky et al.

[Chandelier]

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

Spoiler: Authors

Gensorowsky, Daniel; Fröling, Emma; Braegelmann, Kylie; Diekmannshemke, Jana; Kisser, Agnes; Reuken, Philipp; Noll, Jessica; Blaurock, Julia; Otte im Kampe, Eveline

Abstract​

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.

Spoiler: Disclosures

Disclosures​

D.G., K.B., and J.D. are employees of Vandage GmbH (Bielefeld, Germany).

D.G. is a shareholder of Vandage.

Vandage received funding from Pfizer Pharma GmbH (Berlin, Germany) to conduct the present study. Vandage received further payments from GlaxoSmithKline GmbH & Co. KG (Munich, Germany), Janssen-Cilag GmbH (Neuss, Germany), MSD Sharp & Dohme GmbH (Munich, Germany), Moderna Germany GmbH (Munich, Germany), Sanofi-Aventis Deutschland GmbH (Berlin, Germany), and consulting fees and grants from AOK Rheinland/Hamburg (Düsseldorf, Germany), BARMER (Berlin, Germany), DAK-Gesundheit (Hamburg, Germany), Federal Joint Committee (Berlin, Germany), and Techniker Krankenkasse (Hamburg, Germany).

E.F., A.K., J.N., and J.B. are employees of Pfizer and may own stock or stock options.

P.R. is an employee of Jena University Hospital (Jena, Germany) and received lecture and/or consulting fees from Pfizer Pharma GmbH (Berlin, Germany), BMS (Munich, Germany), Gilead (Munich, Germany), CSL Seqirus (Munich, Germany), AstraZeneca (Hamburg, Germany), and AbbVie (Wiesbaden, Germany).

E.OiK. was an employee of Pfizer at the time of the study but not at publication.

Funding​

This study was sponsored by Pfizer.

Web | DOI | Journal of Health Economics and Outcomes Research | Open Access

 

[rvallee]

I don't know if it's a matter of being used to the framing they use, but most economic analyses of the costs of chronic illnesses never seem to make sense to me, the numbers are just weird, or need a lot of unnecessary untangling that most people won't do, requiring a lot of additional math. I guess the main thing is the use of mean on an issue where outliers make up the bulk of the totals, and they're just presented in a way that doesn't make it obvious.

It's a bit like doing an analysis of a big pile-up on a busy highway where some cars crashed explosively, causing many deaths, total destruction of many vehicles, in some places, but doing an analysis of a large segment of the highway affected by the giant pile-up, as little as simply being delayed and re-routed, hides what happens by making it a mean loss of $1K for all the vehicles and 1.2 life years, since most passengers were not even involved and so incurred zero costs.

Because clearly the reality of the financial toll of this is not being interpreted correctly, and I don't know if it has to do with that, but it's hard not to see the confusion that they create this way as part of the problem.

And they don't even seem to have included lost wages, which will be the bulk of it. There is definitely something that isn't being communicated properly here.