Long financial COVID? After acute phase, costs keep mounting

Georgia Garvey , Contributing News Writer

Much research has been done to document the dangers of COVID-19 to a person’s health and life, effects that can continue even after recovery from the initial acute infection. But less attention has been paid to the long-term health care costs associated with a severe bout of the virus.

A recently published study could help change the conversation.

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The study, “Health Care Costs Following COVID-19 Hospitalization Prior to Vaccine Availability,” was published in the Journal of the American Board of Family Medicine, and compared health care spending for people hospitalized with COVID-19 to those with COVID-19 who were not hospitalized.

Average total health care spending starting 30 days after the initial COVID-19 diagnosis date until year end was 96% higher ($11,242) for those hospitalized with COVID-19, and almost 70% higher ($4,959) even when starting 120 days after the initial diagnosis. 

The data was collected in 2020, prior to the availability of vaccines, which the study’s senior author—Arch Mainous, PhD—said was beneficial.

“It turned out that that limitation was actually a big advantage,” said Mainous, a professor and vice chair for research in the Department of Community Health and Family Medicine at the University of Florida. “It took the availability of vaccination out as a variable, because we have a constant—no one was vaccinated.”

The study builds on previous research showing that “if you can get people vaccinated, it decreases their risk of being hospitalized or [having a] severe episode, which then decreases their risk of dying later [and also] decreases their risk of another hospitalization,” Mainous said, noting that the new findings build on that pathway. “If you can prevent a COVID hospitalization, our new findings show that decreases their risk of major health care costs down the line.”

The study was co-written by several experts from the AMA: Tamkeen Khan, PhD, Stavros Tsipas, Gregory Wozniak, PhD, and Kate Kirley, MD.

Because COVID-19 vaccines can prevent severe cases of the virus, cases that would result in hospitalization or death, Mainous said they’re also the most effective way of preventing big health-care expenses. For insurers, these factors may be influential in encouraging coverage of vaccination, he said.

“It isn't just a benign thing,” someone feeling sick, Mainous said. “You start adding up thousands and thousands and thousands of dollars, so somebody's got to pay that now.”

The magnitude of the cost difference is greatest for those with comorbid factors like hypertension or diabetes, Mainous noted, but having a severe case of COVID-19 is still more expensive months after a hospitalization, even if the patient doesn’t have a preexisting health condition.

“We actually controlled for that, too, in our analysis,” Mainous said, and “you still see that people who end up hospitalized have a significant increased cost,” even after they have passed the acute phase of illness.

The study examined different categories of costs: outpatient services, inpatient services and pharmaceuticals. The largest cost difference between hospitalized and non-hospitalized COVID-19 patients was for inpatient services starting 60 days after their initial COVID-19 case, where costs were, on average, $56,862 higher.

“It's a substantial rise,” Mainous said.

Stay up to date with the AMA COVID-19 resource center for physicians.

The study makes the case for prevention of severe COVID-19, Mainous said, but it also makes the case for continued study of the disease and further development of updated and more effective vaccines. As with flu shots, in which different strains necessitate updated vaccines, COVID-19 will be harder to contain without sustained effort on the vaccine front.

“It's changing, so I think that that we need to be quite vigilant in terms of creating vaccines,” he said. “The prevention may not be as good as it was, as things change, unless we remain vigilant.”

Here is what physicians need to know about the updated COVID-19 vaccine approved in October.