A new study suggests that post-COVID-19 condition (PCC), commonly known as long COVID, has placed a substantial burden on healthcare systems in the years since the onset of the pandemic and is associated with significantly higher healthcare use and costs compared with either COVID infection without lingering symptoms or no history of infection.
For the study, published in the International Journal of Infectious Diseases, researchers led by a team at the University of Groningen in the Netherlands analyzed data from nearly 28,000 participants in a large population-based study in the Netherlands that examined the health and health-related behaviors of more than 150,000 Dutch adults. They found that people with long COVID used nearly every type of healthcare service more frequently than those who recovered fully from COVID or were never infected.
The researchers defined long COVID as “the continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation.”
High costs of long COVID
The researchers estimated that average annual healthcare costs for people with long COVID were €1,136 ($1,315 US) per person, compared with €616 ($713) for people who had COVID without developing ongoing symptoms and €678 ($785) for those who were never infected.
“Except for hospitalizations, costs of the PCC group were substantially higher than costs of the COVID-19 group,” note the researchers.
Primary care visits accounted for the largest share of costs across all groups. Average annual primary care costs per participant in the long COVID group were roughly twice as high as costs in the other two groups (PCC, €434 [$502]; COVID-19, €202 [$234]; control, €216.50 [$250.50]).
Heavy healthcare burden
On average, long-COVID patients consulted with general practitioners (GPs, or primary care practitioners) twice per year. “The relatively high number of GP consultations in the PCC group can likely be explained by the persistence of a wide diversity of symptoms as well as the absence of an effective care pathway,” write the researchers.
Long-COVID patients also averaged six physical therapy visits annually, making it the most commonly used primary care service among that cohort. But the largest difference in primary care use among those with long COVID and those without lingering symptoms or no history of infection was observed for occupational therapy.
Occupational therapy consultation rates were more than eight times higher among those with long COVID than those who were uninfected and more than 20 times higher among those who got COVID but didn’t develop lingering symptoms (PCC to control, 8.7 times; PCC to COVID-19, 20.3 times). Because myalgia (muscle pain) is a common symptom among long-COVID patients, it’s not surprising that physical therapy and occupational therapy visits were relatively high among this group, note the authors.
These numbers reveal the longitudinal impact of PCC on patients, their families, and society, and address the need for dedicated care to this particular group of patients.
Consultation rates for speech therapy were eight times higher among those with long COVID compared with those who were never infected and 14 times higher among those without lingering symptoms (PCC to control, 8.0 times; PCC to COVID-19, 14.2 times).
Long-COVID patients also had the most annual secondary care visits in nine of 15 specialties compared with the other two groups, with the highest difference observed in the “unspecified specialty” category, followed by pulmonology, which focuses on breathing problems.
In addition, people with long COVID received more hours of in-home nursing care and were more likely to attend day-treatment rehabilitation programs. Long-COVID patients also reported significantly greater dependence on informal care from family members and friends—roughly 15 hours per week for people with long COVID, compared with 3.4 in the COVID group and 5.3 hours in the control group.
When the researchers included the value of that unpaid care in their calculations, annual costs for long COVID patients rose nearly 25%.
Findings may help create more efficient care
The emergency phase of the pandemic has ended and the number of new long-COVID cases across the world has decreased, write the authors, yet a significant percentage of long-COVID patients experience persistent symptoms two years after infection. The authors cite previous research suggesting that long-COVID patients who are discharged from the hospital report lower quality of life, decreased exercise capacity, increased mental health issues, and more healthcare use two years after infection.
“These numbers reveal the longitudinal impact of PCC on patients, their families, and society, and address the need for dedicated care to this particular group of patients,” write the researchers. They note that their findings reveal what types of healthcare are primarily used by long-COVID patients and conclude that the data may help policymakers in creating more efficient care pathways for these patients.
“Given that healthcare resources, such as budgets and personnel in both primary and secondary care, are generally growing scarcer, it is important to monitor resource use to identify bottlenecks throughout the care pathway,” they conclude.
