背景:长COVID可能会增加医疗保健利用率和成本。然而,它对NHS的影响还有待确定。
方法:本研究旨在评估长期COVID患者的医疗保健利用率。在NHS英格兰的批准下,我们通过OpenSAFELY使用初级和二级护理数据进行了一项匹配的队列研究,一个分析匿名电子健康记录的平台。长期接触COVID组,由诊断代码定义,在2020年11月至2023年1月之间,与五个没有长COVID的比较器进行了匹配。我们比较了他们在全科医生咨询中的总医疗保健利用率,处方,入院,A&E访问,和门诊预约。使用两部分模型对协变量进行调整来评估医疗保健利用率和成本。使用差异模型,我们还将长期COVID后的医疗保健利用率与大流行前的记录进行了比较。
结果:我们确定了52,988名患有长期COVID诊断的个体,与264,867个没有诊断的比较器匹配。在诊断后的12个月里,有强有力的证据表明,患有长期COVID的人更有可能使用医疗资源(OR:8.29,95%CI:7.74-8.87),医疗保健利用率提高49%(RR:1.49,95%CI:1.48-1.51)。我们的模型估计,长期COVID组每年有30次医疗就诊(预测平均值:29.23,95%CI:28.58-29.92),与对照组的16例相比(预测平均访视:16.04,95%CI:15.73-16.36)。长期COVID的个人更有可能出现非零医疗支出(OR=7.66,95%CI=7.20-8.15),成本比对照组高44%(成本比=1.44,95%CI:1.39-1.50)。长期的COVID小组每人每年的费用约为2500英镑(预测平均费用:2562.50英镑,95%CI:2335.60英镑至2819.22英镑),比较组的成本为1500英镑(预测平均成本:1527.43英镑,95%CI:1404.33-1664.45英镑)。历史上,患有长期COVID的人更频繁地利用医疗资源,但在被诊断为长型COVID后,他们的平均医疗保健利用率增加了更多,与比较器组进行比较。
结论:LongCOVID增加了医疗保健利用率和成本。公共卫生政策应分配更多资源用于预防,治疗,并支持患有长期COVID的个人。
BACKGROUND: Long COVID potentially increases healthcare utilisation and costs. However, its impact on the NHS remains to be determined.
METHODS: This study aims to assess the healthcare utilisation of individuals with long COVID. With the approval of NHS England, we conducted a matched cohort study using primary and secondary care data via OpenSAFELY, a platform for analysing anonymous electronic health records. The long COVID exposure group, defined by diagnostic codes, was matched with five comparators without long COVID between Nov 2020 and Jan 2023. We compared their total healthcare utilisation from GP consultations, prescriptions, hospital admissions, A&E visits, and outpatient appointments. Healthcare utilisation and costs were evaluated using a two-part model adjusting for covariates. Using a difference-in-difference model, we also compared healthcare utilisation after long COVID with pre-pandemic records.
RESULTS: We identified 52,988 individuals with a long COVID diagnosis, matched to 264,867 comparators without a diagnosis. In the 12 months post-diagnosis, there was strong evidence that those with long COVID were more likely to use healthcare resources (OR: 8.29, 95% CI: 7.74-8.87), and have 49% more healthcare utilisation (RR: 1.49, 95% CI: 1.48-1.51). Our model estimated that the long COVID group had 30 healthcare visits per year (predicted mean: 29.23, 95% CI: 28.58-29.92), compared to 16 in the comparator group (predicted mean visits: 16.04, 95% CI: 15.73-16.36). Individuals with long COVID were more likely to have non-zero healthcare expenditures (OR = 7.66, 95% CI = 7.20-8.15), with costs being 44% higher than the comparator group (cost ratio = 1.44, 95% CI: 1.39-1.50). The long COVID group costs approximately £2500 per person per year (predicted mean cost: £2562.50, 95% CI: £2335.60-£2819.22), and the comparator group costs £1500 (predicted mean cost: £1527.43, 95% CI: £1404.33-1664.45). Historically, individuals with long COVID utilised healthcare resources more frequently, but their average healthcare utilisation increased more after being diagnosed with long COVID, compared to the comparator group.
CONCLUSIONS: Long COVID increases healthcare utilisation and costs. Public health policies should allocate more resources towards preventing, treating, and supporting individuals with long COVID.