ABSTRACT
BACKGROUND: The impact of migr2D) and cardiovascular disease (CVD) are associated with increased morbidity and mortality in COVID-19 (C-19) patients. However, the economic burden associated with these pre-existing comorbidities is not well understood. OBJECTIVE(S): This study aimed to compare the healthcare resource utilization (HCRU) and costs among C-19 patients with pre-existing T2D + CVD, T2D only, or neither. METHOD(S): This retrospective study used administrative claims in the HealthCore Integrated Research Database from US commercial and Medicare Advantage health plans. Patients with C-19 were identified from March 1, 2020-May 31, 2021, and stratified by presence of T2D and CVD. HCRU and costs were identified during follow-up and presented on a per patient per month (PPPM) basis. Propensity score matching and multivariable analyses were performed to adjust for differences between the three groups. RESULT(S): A total of 321,232 C-19 patients were identified (21,651 T2D + CVD, 28,184 T2D only, and 271,397 neither) with a mean follow-up of 5.4 months. C-19 patients with T2D + CVD were significantly older and had a greater comorbidity burden than those with neither. The unadjusted analysis shows that PPPM costs during follow-up were $14,790, $5,717, and $1,891 for T2D + CVD, T2D only, and neither, respectively, with C-19 related costs contributing 78%, 75%, and 64% of the overall costs. The majority of costs occurred during the first month after C-19 infection. After matching, 6,967 patients were identified for each cohort. Hospitalization occurred in 34.2% (T2D + CVD), 26.0% (T2D only), and 21.2% (neither), with a mean length of stay of 9.5, 9.9, and 8.9 days. Emergency room visits were reported in 28.6%, 24.5% and 20.4%, respectively. In-person physician and telehealth visits followed a similar pattern, with the highest number of visits among C-19 patients with T2D + CVD. Multivariable models show that C-19 patients with T2D + CVD were 59% more likely to be hospitalized, incurring 54% greater costs than those with neither. Patients with T2D only were 28% more likely to be hospitalized with 21% greater costs than those with neither. CONCLUSION(S): C-19 patients with pre-existing T2D + CVD had the greatest economic burden even after accounting for baseline differences between groups. The magnitude of increased HCRU and costs suggests that more aggressive triage and management of C-19 patients with both T2D and CVD may favorably impact economic outcomes.