Preprint Healthcare Utilisation of 282,080 Individuals with Long COVID Over Two Years: A Multiple Matched Control Cohort Analysis, 2023, Mu et al.

SNT Gatchaman

SNT Gatchaman

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Healthcare Utilisation of 282,080 Individuals with Long COVID Over Two Years: A Multiple Matched Control Cohort Analysis
Mu, Yi; Dashtban, Ashkan; Mizani, Mehrdad A.; Tomlinson, Christopher; Mohamed, Mohamed; Ashworth, Mark; Mamas, Mamas; Priedon, Rouven; Petersen, Steffen E.; Kontopantelis, Evan; Pagel, Christina; Hocaoglu, Mevhibe; Khunti, Kamlesh; Williams, Richard; Thygesen, Johan Hilge; Lorgelly, Paula; Gomes, Manuel; Heightman, Melissa; Banerjee, Amitava

Background
In the UK alone, long Covid(LC) has affected over 2 million individuals, yet health system burden is poorly characterised. Understanding healthcare utilisation will inform clinical, service and policy planning for current and future LC care.

Methods
Using the British Heart Foundation/NHS England Secure Data Environment, we identified individuals ≥18 years of age, diagnosed with LC between January 2020 and January 2023, and age-, sex-, ethnicity-, deprivation-, region-, and comorbidity- matched control groups: (i)COVID only, no LC; (ii)pre-pandemic; (iii)contemporary non-COVID; and (iv)pre-LC(self-controlled, preCOVID pandemic). Healthcare utilisation (number of consultations/visits per person: primary care (GP), secondary care (outpatient[OP], inpatient[IP] and emergency department[ED], investigations and procedures) and inflation-adjusted cost(£) were estimated for LC and control populations per month, calendar year and pandemic year for each category.

Findings
282,080 individuals(median[IQR] age 48.0[36.1, 58.9] years; female:62.4%) with LC were included between January 2020 and January 2023. The control groups were COVID only, no LC(n=1,112,370), pre-pandemic(n=1,031,285), contemporary non-COVID(n=1,118,360) and preLC(n=282,080). Healthcare utilisation per person (per month/year) was higher in LC than controls across GP and OP. For IP and ED, LC had higher healthcare utilisation than all controls but the COVID only, no LC group(all p<0.0001). Healthcare utilisation of the LC group increased progressively between 2020 and 2023, compared to controls. Cost per patient/year was also higher in individuals with LC(£3,350) than all control groups: pre-pandemic: £1,210(average excess cost: -£2,235 95% CI [-£2,284 -£2,187]), COVID only, no LC: £1,283(-£2,035 [-2,081 £1,989]) and pre-LC: £870 (-£2,465 [-£2,554 -£2,376]), except for COVID and no LC: £5,961(£2,683 [£2,593 £2,774])(all p<0.0001). .

Interpretation
LC has been associated with substantial, persistent healthcare utilisation and cost over the last 3 years. Future funding, resources and staff for LC prevention, treatment and research must be prioritised to reduce sustained primary and secondary healthcare utilisation and costs.

Funding
NIHR, HDR UK, NHS England

Link (Lancet Preprints)
 
Annually, individuals with LC had more GP consultations (mean difference 13.43, SD 19.73 per person per year for LC) and OP appointments (3.32, SD 6.50 per person per year for LC) than all control groups
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LC care was estimated to cost over £3000 (~USD 3750) per person per year, nearly four times more than care in the same individuals before the pandemic, and nearly three times as much as care in age- and comorbidity-matched individuals before and during the pandemic. Third, most of the LC healthcare burden was in the first 2 months post-diagnosis, but persisted over the following two years, whether primary care, OP or IP.
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The majority of healthcare burden is in the two months after diagnosis, probably as healthcare professionals try to rule out other diagnoses and pathologies through investigations and treatments. The early healthcare burden may represent more severe disease early in the course of LC, or it may represent the increased investigation load while the diagnosis of LC is established.
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Again, the investment in the basic scientific research in order to (ahem) operationalise metabolomic findings repeatedly reported and not acted on over the last 10 years would stop all this waste of rule-out investigations and ineffective treatments.

I'm a radiologist and yet the only radiology study I had through this was a chest radiograph. I had the benefit of medical knowledge and S4ME to realise that no imaging investigations currently in the clinically available repertoire were going to inform diagnosis or alter management. However, it's not uncommon for people in our local Facebook support group to have seen 20 specialists with multiple imaging and non-imaging investigations, typically with 5 or 10 emergency hospital presentations.

The attempt to minimise costs to governments and insurers by denying and suppressing ME/CFS etc over 30 years has resulted in a healthcare and economic catastrophe. Deferred costs now due.
 
Given that most with Long Covid report finding it impossible to get diagnosed, I don't know what that even means.

Reducing those costs always had the same solution: solve the damn thing, quit covering it up, record what is happening. But they won't be doing they, will they?

All those costs are the payback for decades of wasteful denial and quackery. And it's a massive underestimate. They saved nothing and all they accomplished is to make more people suffer, and for those people to needlessly suffer more. Bravo. Great work, geniuses, you managed the rare lose-lose-lose scenario.
 
rvallee said:
All those costs are the payback for decades of wasteful denial and quackery. And it's a massive underestimate. They saved nothing and all they accomplished is to make more people suffer, and for those people to needlessly suffer more. Bravo. Great work, geniuses, you managed the rare lose-lose-lose scenario.
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The opportunity costs are staggering.
 
rvallee said:
Given that most with Long Covid report finding it impossible to get diagnosed, I don't know what that even means.

Reducing those costs always had the same solution: solve the damn thing, quit covering it up, record what is happening. But they won't be doing they, will they?

All those costs are the payback for decades of wasteful denial and quackery. And it's a massive underestimate. They saved nothing and all they accomplished is to make more people suffer, and for those people to needlessly suffer more. Bravo. Great work, geniuses, you managed the rare lose-lose-lose scenario.
Click to expand...

I think the economic decisions work more on the level of individual gain than system gains.

No one actually cares about saving costs to society of healthcare, nor should they.

But as healthcare administrators they do have to say that this is their goal. They must convince others that they mean it and sometimes accidentally or on purpose also themselves. This is what they are aiming for a massive saving based upon efficiencies (not treating the wrong people) and that it’s their personal professional priority that their institutions work for this goal primarily.

It’s based on the unsupportable premise that there is somewhere, just out of reach a correct amount of money to spend on keeping people healthy that will also be “restrained ” we will of course still have to let people die because sadly the cost benefit analysis didn’t go their way on this occasion, but as a society we will reach the safe shores of controlled and rational (rationing but shush) spending and a “healthy society”, a society minus a few less “cost effective” patients.

But for now they like to say perhaps even believe that we are progressing towards the above stage. That for now we have restricted budgets of different healthcare providers and yet sadly we have the “burden” of an unhealthy society, there are just too many sick people. That these people are probably sick through their own poor choices (this is the part they genuinely hold true) So if we can just reduce the number of sick people through telling them not to be sick and telling them that they’re suffering from moral failure when they request care, with the well grounded assumption that this will sooner or later lead such patients to stop requesting healthcare. Budget protected careers advanced.

I’d say there are plenty of winners.
 
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Now published as —

Healthcare utilisation of 282,080 individuals with long COVID over two years: a multiple matched control, longitudinal cohort analysis
Yi Mu; Ashkan Dashtban; Mehrdad A Mizani; Chris Tomlinson; Mohamed Mohamed; Mark Ashworth; Mamas Mamas; Rouven Priedon; Steffen Petersen; Evan Kontopantelis; Kim Horstmanshof; Christina Pagel; Mevhibe Hocaoğlu; Kamlesh Khunti; Richard Williams; Johan Thygesen; Paula Lorgelly; Manuel Gomes; Melissa Heightman; Amitava Banerjee; on behalf of the CVD-COVID-UK/COVID-IMPACT Consortium

OBJECTIVES
To investigate healthcare utilisation and cost in individuals with long COVID (LC) at population level.

DESIGN
Case–control cohort analysis with multiple age-, sex-, ethnicity-, deprivation-, region-and comorbiditymatched control groups: (1) COVID only, no LC; (2) prepandemic; (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 January 2023.

MAIN OUTCOME MEASURES
Healthcare utilisation (number of consultations/visits per person: primary care (general practitioner [GP]), secondary care (outpatient [OP], inpatient [IP] and emergency department [ED], investigations and procedures) and inflation-adjusted cost (£) for LC and control populations per month, calendar year and pandemic year for each category.

RESULTS
A total of 282,080 individuals with LC were included between January 2020 and January 2023. The control groups were COVID only, no LC (n - 1,112,370), prepandemic (n - 1,031,285), contemporary non-COVID (n - 1,118,360) and pre-LC (n - 282,080). Healthcare utilisation per person (per month/year) was higher in LC than controls across GP, OP and ED. For IP, LC had higher healthcare utilisation than pre-LC and contemporary nonCOVID (all p < 0.0001). Healthcare utilisation of the LC group increased progressively between 2020 and 2023, compared with controls. Median cost per patient/year was also higher in individuals with LC than all control groups.

CONCLUSIONS
LC has been associated with substantial, persistent healthcare utilisation and cost over the last three years. Future funding, resources and staff for LC prevention, treatment and research must be prioritised to reduce sustained primary and secondary healthcare utilisation and costs.

Link | PDF (Journal of the Royal Society of Medicine) [Open Access]
 
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