OBJECTIVES: Acute coronavirus disease 2019 (COVID-19) clinical presentation ranges from asymptomatic to deadly. Estimates of costs therefore vary greatly by severity of disease. Our study analyzed payer costs of COVID-19, by severity type, and comorbidities associated with increased costs.

METHODS: Patients with COVID-19 (first date = index) from April 1, 2020, to February 1, 2021, and ≥ 6 months of continuous enrollment pre- and post-index, in IBM® MarketScan® Commercial and Medicare Supplemental databases, were identified and stratified by severity of disease using the mild, moderate and severe/critical disease signs and symptoms as defined by the Janssen ENSEMBLE Trial. Variables included demographics, comorbidities (Elixhauser index (EI) and all 31 Elixhauser disease domains), and distinct COVID-19 signs and symptoms. Duration of disease was defined as follows: from 5 days before positive test to last related visit/prescription (maximum gap between visit/prescriptions: 35 days). Outcomes were all-cause and disease-specific costs (costs associated specifically with diagnoses of signs or symptoms of respiratory disease) for entire disease duration. Costs were estimated using generalized linear model with gamma distribution and log link. Models also identified variables associated with increased costs, beyond disease severity.

RESULTS: 12,874 Medicare patients with COVID-19 (mean age: 75.0 (standard deviation (SD): 7.4), EI: 2.6 (SD: 2.2), of which: 3,655 severe cases) and 295,681 commercially-insured patients with COVID-19 (mean age: 37.7 (SD: 15.8), EI: 0.6 (SD: 1.1), of which: 17,391 severe) were analyzed. Commercial and Medicare all-cause costs for treatment of severe disease reached $66,020 (95%CI: $62,009-$70,030) and $35,527 (95%CI: $33,387-$37,666) per case/event, respectively. The cost difference between severe and mild disease was $62,772 (95%CI: 58,846-$66,692) for commercial and $31,552 (95%CI: $29,472-$33,632) for Medicare patients.

CONCLUSION: The cost difference between mild, moderate and severe disease is considerable. Interventions, such as vaccines, that decrease the risk for severe disease, will significantly reduce healthcare costs.