ABSTRACT
Objectives: The COVID pandemic has imposed significant direct medical cost and resource use burden on healthcare systems. This study described the patient demographic and clinical characteristics, healthcare resource utilization and costs associated with acute COVID in adults in England. Method(s): This population-based retrospective study used linked primary care (Clinical Practice Research Datalink, CPRD, Aurum) and secondary care (Hospital Episode Statistics) data to identify: 1) hospitalized (admitted within 12 weeks of a positive COVID-19 PCR test between August 2020 and March 2021) and 2) non-hospitalized patients (positive test between August 2020 and January 2022 and managed in the community). Hospitalization and primary care costs, 12 weeks after COVID diagnosis, were calculated using 2021 UK healthcare reference costs. Result(s): We identified 1,706,368 adult COVID cases. For hospitalized (n=13,105) and non-hospitalized (n=1,693,263) cohorts, 84% and 41% considered high risk for severe COVID using PANORAMIC criteria and 41% and 13% using the UKHSA's Green Book for prioritized immunization groups, respectively. Among hospitalized cases, median (IQR) length of stay was 5 (2-7), 6 (4-10), 8 (5-14) days for 18-49 years, 50-64 years and >= 65 years, respectively;6% required mechanical ventilation support, and median (IQR) healthcare costs (critical care cost excluded) per-finished consultant episode due to COVID increased with age (18-49 years: 4364 (1362-4471), 50-64 years: 4379 (4364-5800), 65-74 years: 4395 (4364-5800), 75-84 years: 4473 (4364-5800) and 85+ years: 5800 (4370-5807). Among non-hospitalized cases, older adults were more likely to seek GP consultations (13% of persons age 85+, 9% age 75-84, 7% age 65-74, 5% age 50-64, 3% age 18-49). Of those with at least 1 GP visit, the median primary care consultation total cost in the non-hospitalized cohort was 16 (IQR 16-31). Conclusion(s): Our results quantify the substantial economic burden required to manage adult patients in the acute phase of COVID in England.Copyright © 2023
ABSTRACT
Introduction: Over the last two decades several ECMO survival predictions scores have been developed, with varying internal and external validation. We sought to evaluate the performance of six widely available scores on both our local COVID-19 database and a large international multicenter dataset. Methods: Using an institutional dataset encompassing 15 hospitals in a bi-state region and an international dataset of 42 countries, International Severe Acute Respiratory and emerging Infections Consortium (ISARIC), we evaluated the performance of ECMOnet, Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP), PRedicting dEath for SEvere ARDS on VV-ECMO (PRESERVE), Sequential Organ Failure Assessment (SOFA), Roch and PREdiction of Survival on ECMO Therapy-Score (PRESET) scores in identifying ECMO survival for COVID-19 patients. Results: We identified a total of 67 local and 1,014 ISARIC COVID-19 patients supported on ECMO, with a mortality rates of 48% and 51% respectively. In the local cohort all scores demonstrated poor overall performance with area under the receiver operative curve (AUROC) values between 0.53-0.61;ECMOnet 0.54, RESP 0.53, PRESERVE 0.59, Roch 0.53, PRESET 0.61 and SOFA 0.59. The ISARIC database contained fewer variables, allowing 4 scores to be evaluated. Again, all scores demonstrated poor performance in identifying non-survivors with AUROC between 0.55-0.66;ECMOnet 0.59, Roch 0.66, PRESET 0.55 and SOFA 0.59. Conclusions: Current ECMO prediction scores have poor accuracy and limited clinical utility when applied to both local and international databases of COVID-19 patients. Future work should focus on developing clinically applicable models to identify COVID-19 patients most likely to benefit from ECMO.