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
Objectives: Clinical Practice Research Datalink (CPRD) Aurum contains primary care electronic health records, including vaccinations and nearly complete capture of SARS-CoV-2 PCR test results between August 2020-March 2022. Our objective was to build code lists to define a cohort of persons diagnosed with COVID in England using routinely collected health data. Method(s): Persons aged 1 year or older were indexed on first COVID diagnosis from August 1, 2020 - January 31, 2022. We developed SNOMED code lists to define high risk of severe disease: 1) National Health Service's (NHS) list of highest risk conditions;2) PANORAMIC trial inclusion criteria;3) UK Health Security Agency (UKHSA) clinical risk groups. COVID vaccinations were defined as of December 1, 2021 using medical and product codes. Code lists were developed using wildcard search terms which were reviewed by multiple independent reviewers, and inclusion/exclusion was determined by consensus. All lists for diagnoses were reviewed by a UK physician. Result(s): We identified 2,257,907 people diagnosed in primary care with COVID;46% were male and mean age was 34 years, comparable to governmental data for the same period reporting 47% of cases in England were male and mean age was 34 years. We identified 12% at high risk of severe disease using the NHS definition, 31% using the PANORAMIC trial criteria, and 10% using the UKHSA clinical risk groups. Among adults, 86.1% had >=1 and 80.2% had >=2 COVID vaccine doses (2% and 0.2% lower than official reports, respectively). Conclusion(s): This cohort represented the age and sex distribution of COVID cases, and the COVID vaccination coverage, in England through January 2022. Definitions were built using reproducible methods that can be leveraged for future work. The high capture of COVID vaccinations supports the use of this cohort to examine clinical and societal benefits of COVID vaccination in England.Copyright © 2023
ABSTRACT
Objectives: Clinical Practice Research Datalink (CPRD) Aurum captures primary care electronic healthcare records for ~28% of the population in England. From August 2020-;March 2022, all SARS-CoV-2 polymerase chain reaction (PCR) tests performed were reported back to the patient's general practitioner (GP), making the CPRD a closed system uniquely positioned to answer COVID research questions. Method(s): We defined persons with COVID as those recorded in primary care with a positive PCR test from August 1, 2020-March 31, 2021. We required continuous registration with their GP practice for >=365 days prior to diagnosis to establish comorbid conditions, and eligibility for linkage to Hospital Episode Statistics (HES) Admitted Patient Care data. Hospitalizations for COVID were defined as persons admitted with a primary diagnosis of COVID (ICD-10-CM U07.1) within 12 weeks of the initial primary care diagnosis record. Result(s): Our cohort included 535,453 persons diagnosed in primary care with COVID, with 2% later hospitalized. The hospitalized group was 57% male, 42% current/former smokers, 35% obese46% with a Charlson Comorbidity Index >1 and 98% had never received any COVID vaccine. Hospitalizations increased with age;<0.1% of patients aged 1-17, 1% aged 18-49, 4% aged 50-64, 9% aged 65-74, 13% aged 74-84, and 11% of COVID cases aged >=85 were hospitalized. Persons living in socially disadvantaged areas were overrepresented in the hospitalized cohort (25% in the Index of Multiple Deprivation's most deprived quintile). Conclusion(s): Consistent with other studies, hospitalized COVID patients were disproportionately those with male sex, smoking history, high body mass index, comorbidity and unvaccinated status. Hospitalizations were more common with age, and for individuals living in socially and economically deprived communities. Understanding the demographic and clinical characteristics of this cohort can help contextualize future work describing healthcare resource utilization and costs, as well as the impact of vaccines, associated with COVID in England.Copyright © 2023
ABSTRACT
Introduction: COPD patients are considered at risk of severe COVID-19 illness, however there are limited data on the burden of COVID-19 disease in this patient population. This study investigated the rate of COVID-19 diagnosis and hospitalization for COPD due to COVID-19 (pre-vaccination) over time, stratified by disease severity. Method(s): A retrospective cohort of COPD patients aged >=35 years, FEV1/FVC score <0.7, indexed from Mar-Aug 2020, using the English Clinical Practice Research Datalink Aurum database and Hospital Episode Statistics datasets. Monthly incidence rates of COVID-19 diagnosis and overall inpatient hospitalizations were described for all patients and by GOLD 2019 disease grade. Result(s): The study identified 103,105 COPD patients (mean [SD] age: 69.6 [10.6] years, 54.1% males) with 42.0%, 25.9%, 4.5%, and 6.3% in GOLD A, GOLD B, GOLD C, and GOLD D disease grade groups respectively, in the 12 months prior to index. Results over time are shown in Figure 1. Incidence rates of COVID-19 hospitalization (95% CI) per 100,000 person-days for the Mar-Aug period were GOLD A (2.2 [1.9, 2.6]), GOLD B (4.7 [4.1, 5.4]), GOLD C (4.6 [3.2, 6.3]), and GOLD D (7.9 [6.3, 9.7]). Conclusion(s): Among COPD patients, COVID-19 incidence peaked in April 2020. COVID-19 hospitalization rates were significantly higher in patients with more severe COPD and highest in GOLD D group patients. (Figure Presented).
ABSTRACT
S79 Figure 1ConclusionAmong patients with COPD in routine clinical practice in England, the frequency of moderate and severe exacerbations declined between January 2020 and April 2020 for most stratification groups and remained low through to August 2020. When comparing GOLD grade at baseline, the proportion of patients to experience an exacerbation increased with increasing disease severity grade.Please refer to page A211 for declarations of interest related to this abstract.
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S75 Figure 1ConclusionAmong patients with asthma, the frequency of severe exacerbations declined steeply between March 2020 and May 2020 for all stratification groups and remained low through to August 2020. When comparing GINA step at baseline, a higher proportion of patients in GINA steps 4 and step 5 experienced a severe exacerbation compared with patients in GINA steps 1/2, step 2 and step 3 throughout the observation period. Further research on the long-term impact of COVID-19 on asthma exacerbations in routine clinical practice in England is warranted.Please refer to page A211 for declarations of interest related to this .
ABSTRACT
S39 Figure 1ConclusionAmong patients with asthma, COVID-19 diagnosis rates peaked in April 2020, declined steeply to June 2020 and remained low through to August 2020. COVID-19 hospitalisation rates were substantially higher in patients with more severe asthma and highest among patients in GINA step 5 treatment group. Future studies on the long-term impact of COVID-19 in asthma are warranted.Please refer to page A209 for declarations of interest related to this .