ABSTRACT
Background: The economic consequences of the recent COVID-19 pandemic were substantial. However, direct medical costs in France have not been determined. Objective: To describe patient characteristics, intensity of care, mortality, and direct medical costs in patients hospitalised for COVID-19 infections in France. Study design: A retrospective study of the French national hospital claims database for 2020. Setting: Hospital care. Patients or other participants: All patients hospitalised for COVID-19 in 2020 were included and classified by hospitalisation duration into acute phase and prolonged COVID-19. Intervention: Stratification by intensity of care (Level 1: no or low-flow oxygen support;Level 2: non-invasive ventilation;Level 3: mechanical ventilation). Main outcome measure: Cost of hospital care in 2020 Euros from a payer perspective. Results: 199,455 patients were hospitalised for COVID-19 in France in 2020. 17,824 patients (8.9%) received mechanical ventilation and 32,602 patients (16.3%) died. Mean per patient cost was €5,510 ± 7,142. This cost was highest in patients receiving Level 3 care, patients aged >80 years and in those with prolonged COVID. Conclusion: The economic burden of hospitalisations for COVID-19 infections in France during 2020 was substantial. The study provides robust baseline data to benchmark advances in the standard of care and to nurture epidemiological models. © 2023 Creativ-Ceutical. Published by Informa UK Limited, trading as Taylor & Francis Group.
ABSTRACT
Context Coronavirus disease (Covid-19) is an infectious disease caused by the SARS-CoV-2 virus. The disease can cause symptoms ranging from mild to very severe. People with risk factors as age, gender, medical conditions may be more likely to need hospitalization or intensive care if they have Covid-19, or to die of the infection. A retrospective study based on a national French hospitalized claims database (PMSI) over the year 2020 has been performed to support Covid-19 patient's description but also to describe the disease management with a dedicated focus on ventilation status and finally to describe the health care resource use and the economic impact for treatment of Covid-19 in outpatient patients with more than one risk-factor for severe Covid-19. – Objectives The main objective was to describe patient's characteristics hospitalized for Covid-19. The secondary objectives were to describe the disease management of Covid-19 according to the ventilation status, the health care resource use for and economic impact of Covid-19 disease management in hospital. Method This retrospective observational study identified people with Covid-19 in the PMSI through hospitalisation diagnosis codes in 2020. 4 ventilation status were identified: without and with oxygen support (O2), with non-invasive ventilation (NIV), with mechanical ventilation (MV) based on CCAM acts. Due to underreporting of medical procedure related to oxygen support, status “without oxygen support” was combined to O2 status. In case of several status in the same stay, the most severe was kept. Risk factors were identified through ICD10 codes, DRG and age. Rehospitalizations were calculated for 1st wave stays (from January to June). A minimum delay of 14 days between 2 stays was applied (to not consider transfer as a rehospitalisation). Cost estimation was performed based on health insurance perspective. Results About 200,00 patients for 240,00 stays. 1% of stay were in NIV status, 8% in MV. Median age was 69 years and 54% of patients were men. Men were overrepresented in NIV and MV. 10% of people over 80 had MV. 34% of patients had no risk factor (11% of MV patients, 6% of NIV and 36% of O2). The length of stay increases with the requirement of ventilation support. From a mean of 7 days for O2 to 22 days for MV. 16% of patients died (14% of O2, 25% of NIV, 36% of MV). The mortality rate increase with the age, between 1 and 5% for patients younger than 60 years, 9% for 61-65 years, 13% for 66-70 years, 17% for 71-75, 23% for 76-80 years and 33% for patients older than 80 years old. 14% of 1st wave patients were rehospitalised in 2020. The mean cost of Covid-19 hospitalisation was €5,510 (€+/- 7,142) and the median is €3,800. The mean cost of hospitalisation increased with ventilation support intensity from €3,990 (€+/- 3,021) for O2, up to €10, 600 (€+/- 5,534) for NIV and €21,100 (€+/- 15,343) for MV. Conclusion Age, sex and risk factor increased the severity of ventilation support, cost and mortality rates. Elderly people had less MV support, shorter length of stay and lower cost. In this study, requirement for low-flow oxygen support was largely under-reported, due to many reasons: lack of impact of O2 support on stay valorisation, not specified in the registry, and overload of work leading to enter only the most valuable information in the database. This under-reporting could also apply, to a much lesser extent to non-invasive ventilation, as such procedure is associated with increased stay cost. Conflict of interest VM, KB and KLL are employees of Roche. CL, CB, ALM and AM are employees of Creativ-Ceutical, a contract research organisation under contract with Roche for the implementation and exploitation of this study. Financial support This study was funded by Roche.
ABSTRACT
Introduction La situation sanitaire causée par la COVID-19 est très dynamique, tant au niveau mondial qu'en France, avec à la fois l'arrivée de nouveaux variants et donc des changements de positionnement des traitements, mais une protection accrue contre les formes sévères par les vaccins. Dans ce contexte, il apparaît utile, voire nécessaire d'estimer le poids du fardeau sanitaire et économique de la COVID-19, pour soutenir les choix futurs des allocations de ressources et pour permettre la comparaison avec d'autres maladies. L'objectif de cette étude est d'apporter des premiers éléments de réponse, en présentant les résultats d'un modèle de simulation, simple mais flexible, permettant d'évaluer l'impact de santé publique de la COVID-19 chez les patients français traités en ambulatoire, présentant au moins un facteur de risque de forme sévère. Matériels et méthodes La population d'intérêt est représentée par la population de la cohorte d'autorisation temporaire d'utilisation (ATU) de Ronapreve (moyenne de 63 ans). La première partie de ce modèle de simulation permet de refléter la phase aigüe de la COVID-19 (un mois), avec un arbre de décision. Les patients sont pris en charge soit en ambulatoire soit à l'hôpital, selon des probabilités dérivées de la même cohorte d'ATU. A l'issue de cette phase, les patients peuvent être « en vie sans forme longue », « en vie avec une forme longue traitée en ambulatoire », « en vie avec une forme longue ou prolongée traitée à l'hôpital », ou « décédé ». La seconde partie permet de simuler le devenir des patients sur 2 ans, à l'aide d'une chaîne de Markov. Dans chaque partie du modèle, les caractéristiques des séjours hospitaliers, que ce soit leur durée, la mortalité ou le coût associé, ont été documentées par une analyse de la base de données du PMSI. Plusieurs analyses de scénarios ont été réalisées. Résultats Sur 1 000 patients sont observées 382 hospitalisations, dont 258 au cours du premier mois, 407 formes longues ou prolongées de la COVID-19 et 37 décès. De façon générale, le modèle permet d'estimer le fardeau de la COVID-19 à 0,7 jours de vie perdu le premier mois, avec un coût associé de 1 578 €, et à 27 jours de vie perdus sur l'ensemble de l'horizon temporel, avec un coût associé de 4 280 €. La charge sanitaire et financière la plus élevée est observée pour les patients âgés de plus de 80 ans et pour les patients non vaccinés. Les scénarios menés avec un variant moins sévère, ou avec l'arrivée de nouveaux traitements efficaces permettent de documenter la réduction non négligeable du poids de ce fardeau. Conclusion Cette étude permet de quantifier le fardeau considérable lié à la COVID-19 en France chez les patients infectés et traités en ambulatoire, présentant au moins un facteur de risque de forme sévère. Il semble indispensable de mettre en place des stratégies capables de réduire ce fardeau, en particulier chez les patients les plus vulnérables. Liens d'intérêts déclarés Roche SA France