THE ECONOMIC AND HUMANISTIC BURDEN OF COVID-19 IN HIGH-RISK PEDIATRIC PATIENTS AND THEIR CAREGIVERS
Author(s)
Maria M. Fernandez, PhD, MBA1, David Campbell, PharmD, MS2, Ashley Kang, MPH2, Orianna Li, MD, MS2, Athira Ajith, PharmD2, Rajeev M. Nepal, PhD1, Domenick Francis, PharmD, RPh1, Gurinder S. Sidhu, MD, MHA, MBA3, Shoaib Khan, MD1, Iqra Arham, PharmD, RPh1, Tendai Mugwagwa, PhD4, Kristen Migliaccio-Walle, BS2, Ruth Mokgokong, PhD4.
1Pfizer Inc., New York, NY, USA, 2Curta Inc., Seattle, WA, USA, 3Pfizer Inc., Los Angeles, CA, USA, 4Pfizer Inc., Tadworth, United Kingdom.
1Pfizer Inc., New York, NY, USA, 2Curta Inc., Seattle, WA, USA, 3Pfizer Inc., Los Angeles, CA, USA, 4Pfizer Inc., Tadworth, United Kingdom.
OBJECTIVES: While the burden of COVID-19 among adults with chronic comorbidities is well established, less is known about the economic and health-related quality-of-life (HRQoL) impacts on high-risk pediatric patients and their families. This study assessed the burden of COVID-19 among high-risk children and their caregivers.
METHODS: A systematic literature review was conducted in accordance with PRISMA guidelines (PROSPERO: CRD420251110507). Studies published between January 2022 and June 2025 evaluating pediatric patients (≤18 years) with high-risk conditions were included. Outcomes included hospitalizations, length of stay (LOS), costs, HRQoL, and caregiver burden.
RESULTS: Of 298 full-text articles screened, 77 met inclusion criteria. During the pre-Omicron period (2019-2021), the highest COVID-19-related hospitalization rates in studies with ≥75 patients occurred among children with type 1diabetes (93.3%), immunosuppression (62.7%), neurologic disorder (45.2%), and solid organ transplant (43.8%). Hospitalizations declined during the Omicron era but remained highest among children with bone marrow transplantation (38.6%), diabetes (31.2%), and solid organ transplantation (12.4%). Median LOS ranged from 1-5 days in asthma, sickle cell disease, infants, and transplant populations, but exceeded 7 days in obesity/overweight and immunosuppressive disease populations. Mean hospitalization costs (2020 USD) reached $54,619 in congenital heart disease and $22,113 in patients with severe obesity. Three studies assessed HRQoL in children with Tourette syndrome (TS), juvenile idiopathic inflammatory myopathies, and asthma. Patients with TS experienced worsening HRQoL following infection, including increased tic severity, behavioral dysregulation, anxiety, depressive symptoms, and Long COVID symptoms in more than one-third of patients. One study evaluated caregiver burden using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) tools which identified persistent anxiety among caregivers of pediatric cancer patients with COVID-19.
CONCLUSIONS: COVID-19 imposes a substantial clinical, economic, and humanistic burden on high-risk pediatric populations. Despite declining hospitalization rates, vulnerable children continued to experience prolonged hospitalizations, high healthcare costs, impaired HRQoL, and caregiver distress.
METHODS: A systematic literature review was conducted in accordance with PRISMA guidelines (PROSPERO: CRD420251110507). Studies published between January 2022 and June 2025 evaluating pediatric patients (≤18 years) with high-risk conditions were included. Outcomes included hospitalizations, length of stay (LOS), costs, HRQoL, and caregiver burden.
RESULTS: Of 298 full-text articles screened, 77 met inclusion criteria. During the pre-Omicron period (2019-2021), the highest COVID-19-related hospitalization rates in studies with ≥75 patients occurred among children with type 1diabetes (93.3%), immunosuppression (62.7%), neurologic disorder (45.2%), and solid organ transplant (43.8%). Hospitalizations declined during the Omicron era but remained highest among children with bone marrow transplantation (38.6%), diabetes (31.2%), and solid organ transplantation (12.4%). Median LOS ranged from 1-5 days in asthma, sickle cell disease, infants, and transplant populations, but exceeded 7 days in obesity/overweight and immunosuppressive disease populations. Mean hospitalization costs (2020 USD) reached $54,619 in congenital heart disease and $22,113 in patients with severe obesity. Three studies assessed HRQoL in children with Tourette syndrome (TS), juvenile idiopathic inflammatory myopathies, and asthma. Patients with TS experienced worsening HRQoL following infection, including increased tic severity, behavioral dysregulation, anxiety, depressive symptoms, and Long COVID symptoms in more than one-third of patients. One study evaluated caregiver burden using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) tools which identified persistent anxiety among caregivers of pediatric cancer patients with COVID-19.
CONCLUSIONS: COVID-19 imposes a substantial clinical, economic, and humanistic burden on high-risk pediatric populations. Despite declining hospitalization rates, vulnerable children continued to experience prolonged hospitalizations, high healthcare costs, impaired HRQoL, and caregiver distress.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EPH120
Topic
Clinical Outcomes, Epidemiology & Public Health, Patient-Centered Research
Disease
Infectious Disease (non-vaccine)