Healthcare utilisation and cost among individuals with Long COVID in England and Wales: potential value of specialised […] services, 2026, Dashtban+

[SNT Gatchaman]

Healthcare utilisation and cost among individuals with Long COVID in England and Wales: potential value of specialised post-COVID services
Ashkan Dashtban; Mehrdad Mizani; Yi Mu; Mamas Mamas; Evan Kontopantelis; Spiros Denaxas; Qi Huang; Kamlesh Khunti; Melissa Heightman; Rouven Priedon; Manuel Gomes; Amitava Banerjee on behalf of the CVD-COVID-UK/ COVID-IMPACT Consortium

OBJECTIVE
To compare healthcare utilisation and costs for Long COVID (LC) in England and Wales.

DESIGN
Case–control cohort analysis with multiple age-, sex-, ethnicity-, deprivation-, region- and comorbidity-matched control groups: (1) COVID-only, no LC; (2) pre-pandemic; (3) contemporary non-COVID and (4) pre-LC (self-controlled, pre-COVID pandemic).

SETTING
National, population-based, linked UK electronic health records (British Heart Foundation/NHS England Secure Data Environment).

PARTICIPANTS
Adults aged ⩾18 years with LC between January 2020 and December 2023.

MAIN OUTCOME MEASURES
Healthcare utilisation (number of consultations/visits per person): primary care (general practitioner (GP)), secondary care (outpatient, inpatient and emergency department, investigations and procedures) and inflation-adjusted cost (£) for LC and control populations.

RESULTS
In England (n = 295,180) and Wales (n = 7925), LC was associated with higher utilisation and costs across primary and secondary care. Mean annual total cost for LC versus contemporary controls was £6681.6 versus £2039.9 in Wales (3.27-fold) and £3378.3 versus £1355.8 in England (2.49-fold). GP consultations averaged 26.76 (SD 22.07) per person-year in the Welsh LC cohort versus 14.63 (SD 14.34) in England (absolute difference 12.13 visits/year). Cross-national multiplicative difference-in-differences estimates indicated a 25% greater relative LC-related cost increase in Wales compared with England (ratio 1.25, 95% CI 1.09–1.42), corresponding to an absolute excess of £2501 per person-year (95% CI £1707–£3270).

CONCLUSIONS
LC is associated with sustained increases in healthcare utilisation and costs in England and Wales. Our findings suggest that system-level service design may influence healthcare use and costs following COVID-19, warranting further evaluation of post-viral care models.

Web | DOI | PDF | Journal of the Royal Society of Medicine | Open Access

 

[Chandelier]

Figure 2:

 

[Chandelier]

Analysis by Zdenek Vrozina on Twitter:

---

A large population study from England and Wales (health records, 300,000 people with coded long COVID) measured what LC actually costs the system in care and money. The headline - 2.5-3.3x higher cost per patient than matched controls. Per person-year, across 2020-2023.

Why trust it more than the average LC study? It’s a case-control built on real electronic health records, with every LC patient matched to four separate control groups
had COVID but no LC
the pre pandemic era
contemporaries who never caught COVID
the same people before their LC began (self-control).
Four baselines, four different questions.


The core.
Coded LC patients use more and cost more across the board - GP (family doctor), outpatient, hospital admission, A&E.
Versus COVID free contemporaries- 3.27x (Wales), 2.49x (England).
The authors ran it through four independent stat models, and all four land in nearly the same place.


LC mortality isn’t elevated. The had COVID but no LC group actually dies more (Wales 4.9% vs 3.0% for LC over two years). LC comes out here as a chronic burden on morbidity and cost - not a fatal diagnosis. Too soon.


The most expensive group isn’t LC - it’s had COVID but no LC (W £9,062 vs £6,682 for LC, E £5,805 vs £3,378).
Why that group is so costly? In this era testing was concentrated on severe cases, so COVID-only isn’t mild COVID - it’s enriched for the hospitalised and the sick.


Which means the choice of comparator directly drives how big the effect looks. The 2.5-3.3x only holds against contemporaries, not against every control.


And who are these LC patients anyway? Only 0.2% of Welsh and 0.04% of English records carry an LC code - against a population estimate of 3-5%. These aren’t everyone with long COVID. They’re the diagnostically coded, system-connected sliver of it.
The costs apply to that sliver, not to the LC population.


The 2020-2023 rise in utilisation is partly a rise in coding. GP visits in Wales climb from near-zero (2020) to 20 per patient (2023). The authors acknowledge SNOMED-CT codes arriving in 2021 and growing clinical awareness. So the trend over time is tangled up with how LC came to be recorded - you can’t read it as pure growth in real burden.


The title promises the value of specialised post-COVID services, and the authors do argue for it - not baselessly. England launched a nationwide network of dedicated LC clinics (PCS) in late 2020 and referred nearly half of coded LC patients into it (45.6%).


Those patients visit their GP less than even COVID free contemporaries (0.88x) and are cheaper in absolute terms than Welsh - where care ran mostly through the GP, and the Adferiad programme only came online in June 2021.


The proposed mechanism - a specialist network of dedicated LC clinics concentrates multidisciplinary expertise and streamlines referrals, so the patient doesn’t cycle back to the GP for the same thing. That’s the argument, and it rests on a real, directionally consistent contrast.


Two problems. The first the authors admit themselves. They couldn’t identify who actually used those services. So the claim doesn’t rest on measuring the service - it rests on England having one and Wales mostly not. The Welsh cohort is older and more cardiovascularly ill, England has more respiratory diagnoses, Adferiad launched late.


The second runs deeper, and it’s about money. A British GP is paid mainly by capitation. They get roughly the same for a patient who comes 27 times a year as for one who comes 3 times.


The study costs care as number of contacts x price per contact. So even if the specialist LC clinics trimmed repeat GP visits, that doesn’t save the primary-care budget - it saves the GP’s capacity and time, not pounds. And the Welsh excess in GP visits gets priced as an expenditure it isn’t.


And total cost leaves out medication - dropped because coding differs between the countries, even though Wales codes far more prescriptions (31% vs 19.5% of visits).
So the total isn’t total, and what the total is isn’t straightforwardly what the payer spends.


So a real, sustained load on the health service from coded LC patients - documented.
This is the cost of long COVID, in a population and causal sense - no. It’s the cost of a narrow coded sliver.


Finally some public health study - but overlooked illness = an under measured system.

---