OBJECTIVES: Continued morbidity following Coronavirus disease 2019 (COVID-19), or long COVID (LC), is defined by the World Health Organization (WHO) as conditions lasting > 2 months and identified 3 months after COVID-19 onset. LC might be particularly prevalent in severe COVID-19 patients. The impact of LC on healthcare costs is unknown.

METHODS: Patients with severe/critical COVID-19 (first date =index) from April 1, 2020, onwards, with ≥ 6 months of continuous enrollment pre- and post-index, in IBM® MarketScan® Commercial and Medicare Supplemental databases, were identified. Severe disease was defined as admissions with respiratory distress/failure, with or without organ/neurological dysfunction or shock/tachypnea/tachycardia/hypoxemia. Variables for all patients included demographics, comorbidities (Elixhauser index (EI) and all 31 Elixhauser disease domains), and COVID-19 signs/symptoms. Disease duration was defined as follows: from 5 days before positive test to last related visit/prescription. A ≤ 35-day gap between visits/prescription was allowed. LC was defined as disease duration ≥ 5 months. All-cause (with any diagnostic code) and disease-specific costs (with COVID-19 related diagnostic codes) for patients with and without LC (non-LC) were estimated from index to end of disease duration or last available date (for ongoing disease), using generalized linear model with gamma distribution and log link.

RESULTS: 13.7% (95%CI: 13.5%-13.9%) with severe/critical COVID-19 had LC. Average available duration of LC for costing analyses was 213.1 days (95%CI: 207.8-218.3). In contrast, non-LC duration of disease averaged 53.6 days (95%CI: 53.1-54.2) Between LC and non-LC patients, all-cause costs significantly increased in commercially-insured and Medicare patients by respectively $58,445 (95%CI: $49,453-$67,437 – from $46,912 (non-LC) to $105,357 (LC)) and $34,940 (95%CI: $28,990-$40,889 – from $29,491 (non-LC) to 64,412 (LC)).

CONCLUSION: As observed over 213 days, all-cause cost of COVID-19 almost doubled in severe COVID-19 patients with LC vs without LC. These costs are expected to further increase with increased follow-up time.