The Acute and Long-Term Healthcare Costs Attributable to COVID-19 in Ontario, Canada: A Population-Based Matched Cohort Study

OBJECTIVES: Comprehensive data on health system costs due to COVID-19 infections, especially for long-term disability (post COVID-19 condition) are scarce. We characterized COVID-19-attributable costs from the health system perspective.

METHODS: Population-based matched cohort study using Ontario, Canada, health administrative data. We hard- and propensity score-matched exposed individuals (positive SARS-CoV-2 PCR test, 01/2020-12/2020) 1:1 to unexposed individuals (01/2016-12/2018), accounting for restricted healthcare during the pandemic and contamination bias. We used phase-of-care costing to calculate mean attributable per-person costs (2023 CAD), standardized to 10 days, during four phases of illness: pre-index date, acute care, post-acute care (indicative of PCC), and terminal phase (stratified into early deaths and late deaths). Combining costs with survival estimates, we calculated total costs at 360 days.

RESULTS: Of 165,838 exposed individuals, we matched 159,817 (mean age 41±20, 51% female, 32% highest two income quintiles, 49% moderate resource utilization band). Mean (95%CI) COVID-19-attributable 10-day per person costs were $1 ($-4, $6) during pre-index, $240 ($231, $249) during acute care, and $18 ($14, $21) during post-acute phases. During the terminal phase, mean attributable 10-day costs were $3,927 ($3,471, $4,384) and $1,781 ($1,182, $2,380) for early and late deaths, respectively. Hospitalizations accounted for 42% to 100% of total phase costs. Compared to males, costs among females were lower during the acute care, but higher during the post-acute care phase. Costs in acute and post-acute care phases were higher among older age groups, individuals living in lower income neighbourhoods, and individuals in higher resource utilization bands. Mean cumulative per person cost at 360 days were $2,553 ($2,348, $2,756); females had lower costs ($2,194 [$1,945, $2,446]) than males ($2,921 [$2,602, $3,241]).

CONCLUSIONS: SARS-CoV-2 infection is associated with substantial long-term healthcare costs, consistent with our understanding of the post COVID-19 condition. Understanding phase-specific cost can inform health sector budget planning, future economic evaluations, and pandemic planning.