Higher Post-Acute Health Care Costs Following SARS-CoV-2 Infection Among Adults in Ontario, Canada

Candace D McNaughton,1– 4 Peter C Austin,1,2,4 Zhiyin Li,1 Atul Sivaswamy,1 Jiming Fang,1 Husam Abdel-Qadir,1,3– 5 Jacob A Udell,1,5 Walter P Wodchis,1,4,6 Douglas S Lee,1,3,4,7 Ivona Mostarac,2 Clare L Atzema1– 4 1ICES (Formerly, the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada; 2Sunnybrook Research Institute, Toronto, Ontario, Canada; 3Department of Medicine, University of Toronto, Toronto, Ontario, Canada; 4Institute of Health Policy, Management and Evaluation, Toronto, ON, Canada; 5Division of Cardiology, Women’s College Hospital, Toronto, Ontario, Canada; 6Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada; 7Ted Rogers Centre for Heart Research, Toronto, Ontario, CanadaCorrespondence: Candace D McNaughton, Email [email protected] and Introduction: Growing evidence suggests SARS-CoV-2 infection increases the risk of long term cardiovascular, neurological, and other effects. However, post-acute health care costs following SARS-CoV-2 infection are not known.Patients and Statistical Methods: Beginning 56 days following SARS-CoV-2 polymerase chain reaction (PCR) testing, we compared person-specific total and component health care costs (2020 CAD$) for the first year of follow-up at the mean and 99th percentiles of health care costs for matched test-positive and test-negative adults in Ontario, Canada, between January 1, 2020, and March 31, 2021. Matching included demographics, baseline clinical characteristics, and two-week time blocks.Results: For 531,182 people, mean person-specific total health care costs were $513.83 (95% CI $387.37-$638.40) higher for test-positive females and $459.10 (95% CI $304.60-$615.32) higher for test-positive males, which were driven by hospitalization, long-term care, and complex continuing care costs. At the 99th percentile of each subgroup, person-specific health care costs were $12,533.00 (95% CI $9008.50-$16,473.00) higher for test-positive females and $14,604.00 (95% CI $9565.50-$19,506.50) for test-positive males, driven by hospitalization, specialist (males), and homecare costs (females). Cancer costs were lower. Six-month and 1-year cost differences were similar.Conclusion: Post-acute health care costs after a positive SARS-CoV-2 PCR test were significantly higher than matched test-negative individuals, and these increased costs persisted for at least one year. The largest increases health care costs came from hospitalizations, long-term care, complex continuing care, followed by outpatient specialists (for males) and homecare costs (for women). Given the magnitude of ongoing viral spread, policymakers, clinicians, and patients should be aware of higher post-acute health care costs following SARS-CoV-2 infection.Plain Language Summary: We examined differences in health care costs for people who had a positive PCR for SARS-CoV-2 in Ontario, Canada, starting 56 days after the positive test at looking forward at least 1 year, matched by > 20 characteristics to people with a negative PCR within two weeks. During the study, the average health care costs per person were approximately $4800 (2020 CAD$). We found that on average, health care costs were $513.83 higher (2020 CAD$; +11% higher than average health care costs) for women who had a positive PCR test and $459.10 higher (+10% higher than average health care costs) for men who had a positive PCR test. Most of the increased costs were due to hospitalization, long-term care, and complex continuing care costs.When we looked at people who had the highest health care costs (the 99th percentile), health care costs for women with a positive PCR test were $12,533.00 higher (+261% higher than average health care costs) and $14,604.00 higher for men (+304% higher than average health care costs), with higher costs driven by hospitalization, specialist (males), and homecare costs (females). Cancer costs were lower for people with a positive test. In summary, post-acute health care costs were higher for people who had a positive SARS-CoV-2 PCR test, after accounting for multiple patient-level factors. Higher costs persisted for a least one year of follow-up.Keywords: long COVID, health policy, sex difference

Underuse of medication for circulatory disorders among unmarried women and men in Norway?

BACKGROUND: It is well established that unmarried people have higher mortality from circulatory diseases and higher all-cause mortality than the married, and these marital status differences seem to be increasing. However, much remains to be known about the underlying mechanisms. Our objective was to examine marital status differences in the purchase of medication for circulatory diseases, and risk factors for them, which may indicate underuse of such medication by some marital status groups. METHODS: Using data from registers covering the entire Norwegian population, we analysed marital status differences in the purchase of medicine for eight circulatory disorders by people aged 50-79 in 2004-2008. These differences were compared with those in circulatory disease mortality during 2004-2007, considered as indicating probable differences in disease burden. RESULTS: The unmarried had 1.4-2.8 times higher mortality from the four types of circulatory diseases considered. However, the never-married in particular purchased less medicine for these diseases, or precursor risk factors of these diseases, primarily because of a low chance of making a first purchase. The picture was more mixed for the divorced and widowed. Both groups purchased less of some of these medicines than the married, but, especially in the case of the widowed, relatively more of other types of medicine. In contrast to the never-married, divorced and widowed people were as least as likely as the married to make a first purchase, but adherence rates thereafter, indicated by continuing purchases, were lower. CONCLUSION: The most plausible interpretation of the findings is that compared with married people, especially the never-married more often have circulatory disorders that are undiagnosed or for which they for other reasons underuse medication. Inadequate use of these potentially very efficient medicines in such a large population group is a serious public health challenge which needs further investigation. It is possible that marital status differences in use of medicines for circulatory disorders combined with an increasing importance of these medicines have contributed to the widening marital status gap in mortality observed in several countries. This also requires further investigation