ABSTRACT
Objectives: Assess real-world evidence data on the prevalence and impact of long COVID (LC) to establish a baseline for the value of potential therapeutic interventions. Method(s): This study was a retrospective, longitudinal analysis of administrative claims from multiple payer channels spanning 4/1/2020-6/30/2022. Inclusion criteria: 1) ICD-10-CM diagnosis code of COVID-19 (U07.1) on or after 4/1/2020 (COVID-19 diagnosis date=index date), 2) 18+ years of age on index, and 3) at least -365/+30 days of continuous plan enrollment surrounding index. Employing a conservative LC definition, patients were classified as LC if they presented at least 1 claim >= 28 days following the index date which included both a COVID-19 diagnosis and >=1 of 8 LC-related symptoms. LC and non-LC patients were compared on demographics, COVID-19 symptoms, healthcare utilization, and medical costs. Descriptive statistics were presented for outcomes, and bivariate tests of significance were used to assess differences between cohorts. Result(s): Of 4,938,801 medically attended COVID-19 patients meeting inclusion criteria, 386,153 (7.8%) qualified as LC. The LC patients were older (Mean(SD) = 67.0(19.0) vs. 51.0(20.7)), were more likely to be female (65.1% vs. 60.4%), were in poorer health (Deyo-Charlson Comorbidity Index=3.51(3.24) vs. 1.47(2.45)), and presented greater baseline total medical expenditures ($39,769($60,401) vs. $15,275($35,640);p < 0.0001). On index, LC patients had a higher rate of LC-related symptoms, and in the 180-day post-index period, LC patients incurred increased total medical costs ($38,874($54,098) vs. $7,319($18,439);p < 0.001) and greater use of inpatient and outpatient medical services. Conclusion(s): Patients with LC presented elevated rates of symptoms and incurred 5-fold greater medical costs post-index compared to non-LC patients. This study is one of the first to longitudinally quantify the cost and symptom burden of LC in a real-world setting and helps to establish a baseline for the value of potential therapeutic interventions.Copyright © 2023
ABSTRACT
Objectives: Efforts to combat COVID-19 have largely focused on vaccination and non-pharmaceutical interventions to decrease hospitalization and death and to reduce transmission. First generation COVID-19 direct-acting antivirals (DAAs) are only authorized for high-risk patients to reduce individual risk of disease progression. However, DAAs can also impact transmission by reducing viral load, thereby shortening the duration of infectivity. Next generation oral DAAs in development may have safety profiles that are amenable to broader eligibility and use. This analysis estimates the economic and clinical impact of increasing the utilization of DAAs to treat COVID-19. Method(s): A susceptible-infected-recovered-susceptible model was developed to estimate COVID-19-related outcomes based on DAA uptake. Cost-savings modeled included reduced healthcare utilization amongst individual patients and, importantly, potential savings attributable to reduced transmission. Cost inputs included treatment acquisition costs, adverse events, healthcare utilization, and productivity losses based on published literature. One million individuals were assessed with clinical and economic outcomes estimated for DAA adoption by risk level. Result(s): The model projects 402,330 new infections per 1 million individuals annually, leading to 6,000 hospitalizations and 107 deaths. By increasing DAA use by 10% in the high-risk population and 20% in the standard-risk population, infections decreased to 312,000, with 1,800 fewer hospitalizations and 34 fewer deaths. Decreases in medical encounters were driven by reduction in transmission (77% of the decrease) and reduction in severity amongst those treated (23% of the decrease). Among deaths averted, 72% were attributable to the reduction in transmission. Overall, costs decrease by 23.5% with increased treatment. Conclusion(s): This study is among the first to model the potential population-level impact of DAAs in reducing infectivity and transmission, a factor currently under-emphasized in the literature. New DAAs under development with potentially improved safety profiles may expand the uptake of treatment and substantially reduce the clinical and economic burden of COVID-19.Copyright © 2023