Health Care Costs Following COVID-19 Hospitalization Prior to Vaccine Availability

Tamkeen Khan; Stavros Tsipas; Gregory D. Wozniak; Kate Kirley; Arch G. Mainous

doi:10.3122/jabfm.2023.230069R1

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Table 1.

Baseline Characteristics of the COVID-19 Patients in the Cohort

	Full Sample N (%)	Hospitalized N (%)	Not Hospitalized N (%)	Chi-sq p-Value
Total Sample	567,320 (100)	7,633 (1)	559,687 (99)
Sex				<0.001
Male	254,360 (45)	4,088 (54)	250,272 (45)
Female	312,960 (55)	3,545 (46)	309,415 (55)
Age				<0.001
18 to 34 years	211,392 (37)	631 (8)	210,761 (38)
35 to 44 years	116,553 (21)	1,034 (14)	115,519 (21)
45 to 54 years	125,308 (22)	2,375 (31)	122,933 (22)
55 to 64 years	114,067 (20)	3,593 (47)	110,474 (20)
Region				<0.001
Northeast	194,057 (34)	1,934 (25)	192,123 (34)
North Central	54,685 (10)	831 (11)	53,854 (10)
South	238,016 (42)	4,097 (54)	233,919 (42)
West	80,132 (14)	766 (10)	79,366 (14)
Unknown	430 (<1)	5 (<1)	425 (<1)
Employee classification				<0.001
Salary Non-union	44,025 (8)	497 (7)	43,708 (8)
Salary Union	522 (<1)	11 (<1)	511 (<1)
Salary Other	17,532 (3)	134 (2)	17,398 (3)
Hourly Non-union	12,115 (2)	215 (3)	11,900 (2)
Hourly Union	17,982 (3)	516 (7)	17,466 (3)
Hourly Other	22,293 (4)	447 (6)	21,846 (4)
Non-union	5,358 (<1)	104 (1)	5,254 (1)
Union	422 (<1)	23 (<1)	399 (<1)
Unknown	446,891 (79)	5,686 (74)	441,205 (79)
Employee status				<0.001
Active full-time	419,673 (74)	4,153 (54)	415,520 (74)
Active part-time or seasonal	4,868 (<1)	80 (1)	4,788 (<1)
Early Retiree	7,818 (1)	261 (3)	7,557 (1)
Medicare Eligible Retiree	1,355 (<1)	84 (1)	1,271 (<1)
Retiree (status unknown)	41 (<1)	0 (0)	41 (<10)
COBRA Continuee	1,793 (<1)	29 (<1)	1,764 (<1)
Long Term Disability	341 (<1)	33 (<1)	308 (<1)
Surviving Spouse/Depend.	739 (<1)	33 (<1)	706 (<1)
Other/Unknown	130,692 (23)	2,960 (39)	127,732 (23)
Month of encounter				<0.001
January	34 (<1)	0 (0)	34 (<1)
February	45 (<1)	1 (<1)	44 (<1)
March	6,577 (1)	476 (6)	6,101 (1)
April	23,281 (4)	1,160 (15)	22,121 (4)
May	52,120 (9)	360 (5)	51,760 (9)
June	76,540 (13)	603 (8)	75,937 (14)
July	82,929 (15)	891 (12)	82,038 (15)
August	49,334 (9)	506 (7)	48,828 (9)
September	46,767 (8)	385 (5)	46,382 (8)
October	56,784 (10)	617 (8)	56,167 (10)
November	81,066 (14)	1,147 (15)	79,919 (14)
December	91,843 (16)	1,487 (19)	90,356 (16)
Other conditions (not mutually exclusive)^a,b
Hypertension	73,278 (13)	2,981 (39)	70,297 (13)	<0.001
Diabetes	33,346 (6)	1,959 (26)	31,387 (6)	<0.001
Depression	29,759 (5)	611 (8)	29,148 (5)	<0.001
CHF	156 (<1)	12 (<1)	144 (<1)	<0.001
COPD	3,099 (<1)	179 (2)	2,920 (<1)	<0.001
Cancer	11,771 (2)	342 (4)	11,429 (2)	<0.001

^aColumn percentage displayed are compared with those without the diagnosis of the condition (results not shown).
^bChi-sq p-values are computed including those without the diagnosis of the condition (results not shown).
Abbreviations: COBRA, consolidated omnibus budget reconciliation act; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease.

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Table 2.

Average Medical Expenditures by Sector for COVID-19 Patients with Initial COVID-19 Hospitalization and COVID-19 Diagnosis but No Hospitalization

		Unmatched		Matched Treatment Effect
	Case Subjects $	Control Subjects $	Difference $	Control	Difference $
	(n)	(n)	(%)	Subjects $	(%)
Outpatient services
30 days	6,458 (4843)	2,856 (315,888)	3,602 (77)	3,477	2,981*** (60)
60 days	6,386 (3724)	2,610 (257,627)	3,776 (84)	3,342	3,044*** (63)
120 days	4,872 (2622)	1,934 (166,900)	2,937 (86)	2,922	1,950*** (50)
Inpatient admissions and services
30 days	93,597 (512)	46,381 (5294)	47,216 (67)	48,756	44,841*(63)
60 days	105,524 (333)	45,584 (4034)	59,940 (79)	48,662	56,862* (74)
120 days	67,404 (171)	42,691 (2050)	24,714 (45)	44,204	23,200** (42)
Pharmaceuticals
30 days	2,533 (4000)	1,600 (248,703)	933 (45)	2,054	479** (21)
60 days	2,438 (3159)	1,476 (202,328)	963 (49)	1,974	464** (21)
120 days	1,854 (2232)	1,120 (130,261)	734 (49)	1,525	329* (19)
Total
30 days	17,329 (5155)	4,380 (352,895)	12,949 (119)	6,087	11,242*** (96)
60 days	16,486 (4041)	4,005 (288,316)	12,481 (122)	6,093	10,393*** (92)
120 days	9,729 (2923)	2,897 (192,065)	6,832 (108)	4,770	4,959*** (68)

Notes: Statistical significance (*P < .05, **P < .01, ***P < .001) using z-score; All spending is assessed 30, 60 or 120 days after the COVID-19 index data till the end of the calendar year. The difference for control subjects in both the unmatched and matched models is relative to the cases subjects.

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Table 3.

Average Medical Expenditures by Sector for COVID-19 Patients with Hypertension and/or Diabetes with Initial COVID-19 Hospitalization and COVID-19 Diagnosis but No Hospitalization

		Unmatched		Matched Treatment Effect
	Case Subjects $	Control Subjects $	Difference $	Control	Difference $
	(n)	(n)	(%)	Subjects $	(%)
Outpatient services
30 days	7,222 (2161)	4,157 (53,101)	3,064 (54)	4,073	3,149*** (56)
60 days	6,938 (1721)	3,759 (44,857)	3,180 (59)	4,083	2,855*** (52)
120 days	5,290 (1245)	2,705 (31,297)	2,586 (65)	3,120	2,170*** (52)
Inpatient admissions and services
30 days	110,933 (270)	50,097 (1703)	60,836 (76)	45,475	65,458 (84)
60 days	123,336 (189)	49,886 (1324)	73,450 (85)	45,318	78,018 (93)
120 days	70,525 (96)	46,972 (707)	23,553 (40)	59,004	11,521 (18)
Pharmaceuticals
30 days	3,090 (1887)	2,382 (48,597)	708 (26)	2,574	516 (18)
60 days	2,993 (1522)	2,150 (40,666)	843 (33)	2,280	713** (27)
120 days	2,241 (1104)	1,533 (28,691)	708 (38)	1,818	423 (21)
Total
30 days	22,285 (2306)	7,704 (59,635)	15,211 (97)	7,327	14,958*** (101)
60 days	21,424 (1858)	6,407 (50,274)	15,018 (108)	6,953	14,471** (102)
120 days	11,464 (1381)	4,452 (36,348)	7,011 (88)	5,502	5,962*** (70)

Notes: Statistical significance (*P < .05, **P < .01, ***P < .001) using z-score; All spending is assessed 30, 60 or 120 days after the COVID-19 index data till the end of the calendar year. The difference for control subjects in both the unmatched and matched models is relative to the cases subjects.

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Table 4.

Average Medical Expenditures by Sector for COVID-19 Patients without Hypertension and/or Diabetes with Initial COVID-19 Hospitalization and COVID-19 Diagnosis but No Hospitalization

		Unmatched		Matched Treatment Effect
	Case Subjects $	Control Subjects $	Difference $	Control	Difference
	(n)	(n)	(%)	Subjects $	$
Outpatient services
30 days	5,844 (2682)	2,593 (262,787)	3,250 (77)	3,000	2,844*** (64)
60 days	5,911 (2003)	2,367 (212,770)	3,543 (86)	2,960	2,951*** (67)
120 days	4,493 (1377)	1,757 (135,603)	2,737 (88)	2,329	2,164*** (63)
Inpatient admissions and services
30 days	74,255 (242)	44,618 (3591)	29,637 (50)	45,852	28,403** (47)
60 days	82,144 (144)	43,482 (2710)	28,662 (62)	49,138	33,006* (50)
120 days	63,409 (75)	40,436 (1343)	22,972 (44)	49,595	13,814 (24)
Pharmaceuticals
30 days	2,035 (2113)	1,410 (200,106)	625 (36)	1,614	421* (23)
60 days	1,923 (1637)	1,306 (161,662)	617 (38)	1,539	384* (22)
120 days	1,475 (1128)	1,004 (101,570)	471 (38)	1.191	284 (21)
Total
30 days	13,317 (2849)	3,832 (293,260)	9,486 (111)	4,690	8,627*** (96)
60 days	12,283 (2183)	3,498 (238,012)	8,786 (111)	4,327	7,956*** (96)
120 days	8,175 (1542)	2,533 (155,717)	5,641 (105)	3,380	4,795*** (83)

Notes: Statistical significance (*P < .05, **P < .01, ***P < .001) using z-score; All spending is assessed 30, 60 or 120 days after the COVID-19 index data till the end of the calendar year.