OBJECTIVES: The COVID-19 pandemic has placed significant strain on healthcare resources, particularly in the management of patients requiring hospitalisation for severe disease. We describe resource use and costs associated with the management of hospitalised COVID-19 patients during the pandemic in England.

METHODS: This retrospective observational study utilised data from the Hospital Episode Statistics database. Patients with COVID-19 (ICD-10 code U07.1) as the primary reason for hospital admission between 1^st January 2020 to 30^th September 2021 and who were at high risk of severe COVID-19 (aged ≥55 years, or aged ≥12 years with specified comorbidities) were included. Hospital costs were derived from National Health Service Reference Costs 2019–2020. Analyses were stratified into pandemic wave one (1^st January – 31^st May 2020), wave two (1^st June 2020 – 24^th April 2021), and wave three (25^th April – 30^th September 2021).

RESULTS: The analysis identified 66,723 eligible patients during wave one, 181,479 patients during wave two, and 39,917 patients during wave three. Total admission costs per patient declined over the three waves, with mean (standard deviation [SD]) total costs per admission of £5,862 (£14,024), £5,077 (£11,647), and £4,383 (£8,468) for wave 1, wave 2, and wave 3, respectively. The length of hospital stay per admission also declined across the three waves, with mean (SD) of 12.00 (14.59), 11.00 (13.16), and 7.00 (8.41) days for wave 1, wave 2, and wave 3, respectively. The proportion of patients admitted to critical care was similar across the three waves (wave one, 12.2%; wave two, 12.0%; wave three, 12.8%), while the proportion who died in hospital declined (wave one, 33.98%; wave two, 24.24%; wave three, 11.32%).

CONCLUSIONS: COVID-19 continues to represent a substantial cost and resource burden to patients and hospital services across England, although per-patient costs have declined over the course of the pandemic.