Résilience - COVID-19 - Résilience - Coronavirus disease 2019

Burden of care of long COVID-19 patients after hospital discharge – BLOC

Burden of care of long COVID-19 patients after hospital discharge

Patients with COVID-19 may present “long COVID” syndrome, i.e. persistent set of symptoms, more than 4 weeks after the initial phase of the disease. Patients hospitalized for COVID-19 may be at higher risk of presenting long COVID than non-hospitalized patients. The project investigates healthcare resource use and corresponding costs of hospitalized and discharged COVID-19 patients with persisting and high rate use of claims after 4 weeks following discharge.

Why study healthcare ressource use in long COVID syndrome?

The definition of post-COVID syndrome is still not consensual. The French Health Authority (HAS) considers “long COVID” for patients with symptoms persisting for at least 4 weeks. It has published specific recommendations for the management of patients presenting long COVID forms. However, the British National Institute for Health and Care Excellence (NICE) defines the term “long COVID” as “signs and symptoms that develop during or after an infection consistent with COVID-19, continue for more than 12 weeks and are not explained by an alternative diagnosis. It usually presents with clusters of symptoms, often overlapping, which can fluctuate and change over time and can affect any system in the body. Post-COVID-19 syndrome may be considered before 12 weeks while the possibility of an alternative underlying disease is also being assessed”. <br />Several studies have described the epidemiology of long COVID among hospitalized COVID-19 patients. They report various symptoms persisting weeks or months after discharge, from fatigue (the most commonly cited symptom) to various impairments in physical, cognitive function, and/or emotional health. In France, the ongoing community-based study “COMPARE COVID-long” identified up to 50 symptoms of 10 domains (PROM- Patients Reported Outcome Measurement) persisting more than 3 weeks after COVID-19 convalescence. In combination with various painful symptoms such as diffuse myalgia, arthralgia, abdominal pain, headache, and chest pain, the symptomology of long COVID calls for the myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). In the context of the COVID-19 pandemic, one can expect considerably higher number of patients to develop ME/CFS-like post-COVID syndrome, which has been shown to be associated with a substantial economic burden.<br />Taken together, consequences of the long COVID syndrome are likely to increase the long-lasting health care burden of COVID-19, particularly for non-communicable chronic diseases, mental health, prolonged medical leaves, functional disability and chronic pain. All the conditions identified to be associated with long COVID are associated with high medical resource use and large economic burden, that can be assessed using the identification of high-rate use of claims. There is thus an urgent need to evaluate the long-term MRU and health care burden incurred by patients with long COVID, as well as risk factors for long COVID.<br /><br />The objectives of this study are:<br />(1) to investigate whether different patterns of long COVID medical resource use (MRU) may be identified. <br />(2) to assess long COVID patients’ MRU and health care burden (costs) and to compare their MRU and costs to those from COVID patients without high rate use of claims, <br />(3) to identify predictive variables for the development of long COVID.

Data source: Système National des Données de Santé (SNDS), the French NHS claims data.

Design: retrospective cohort study

Patient population: COVID-19 patients discharged from all French hospitals from 01 February to 30 June 2020 (inclusion period).

Inclusion criteria:
• Aged 18 years or more
• Patients hospitalized between February 1st and June 30st 2020 for COVID-19 as the main diagnosis, using the following ICD-10 discharge codes: U07.10, U07.11, U07.14, U07.15
• Patients alive at the date of discharge

Index date: date of discharge during the inclusion period.

Follow-up duration: until December 31, 2020, with a maximum duration of follow-up of 6 months.

Identification of the long COVID patients:
Based on the most common symptoms of long COVID described by the Haute Autorité de santé, we will develop specific algorithms to identify patients presenting long COVID over the follow-up period. The algorithm will be based on the use of specific treatments (eg, NSAIDs, painkillers) and resource use (e.g. physiotherapy). As we are aware that theses algorithms are exploratory, we will distinguish patients with “likely” long COVID, patients with “possible” long COVID, and patients “unlikely to have long COVID”.

Outcomes
Primary outcomes:
- description of MRU and related costs during the 6 months following the discharge date: medications, medical, emergency room visits, paramedical visits, specific therapies including pain management, medical procedures, biological acts, new hospitalizations (for any reason), sick leaves, transportation
- patterns of long COVID healthcare consumption
- sociodemographic and clinical characteristics of selected patients: age at hospital admission, sex, chronic disease and free-access-to-care status, type of hospitalization (conventional versus intensive care unit).
Secondary outcomes: predictive variables for long-COVID, i.e. identified risk factors for developing long COVID

From the selected patients, we will create two sub-cohorts: 1) the long COVID patients, and 2) the non-long COVID patients.

Statistical analyses. We will compare:
• The MRU and the costs between the long COVID patients and the non long COVID patients, after propensity score matching on age, sex, free-access-to-care status, region of residence and comorbidities, ICU stays, use of assisted-breathing
• The MRU and the costs between similar periods in 2019 and 2020, distinctly in long COVID patients and in non long COVID-19 patients.
We will compare all-cause MRU costs between patients using generalized linear models with gamma distribution and log-link function. As gamma models are defined for positive values only, two-part models will be used for items with no strictly positive costs.

No results available to date

This part will be completed after results have been released.

No scientific production to date

Since March 2020, 3.5 million people have been infected with SARS-COV2 in France, and about 250 000 patients have been hospitalized and successfully discharged.
In a majority of cases, the evolution of the disease is favourable, but both hospitalized or patients with a mild form of the disease may present so called “Long-COVID” syndrome - a patient-created term which describes the effects of COVID-19 that continue for weeks or months beyond the initial symptoms. There is thus an urgent need to evaluate the long-term medical resource utilisation (MRU) and health care burden incurred by patients with Long-COVID, as well as risk factors for Long-COVID.

The objectives of this study are:
(1) to assess “long-COVID” patients’ medical resource use (MRU) and health care burden (costs) and to compare their MRU and costs to those from COVID patients without persistent symptoms,
(2) to identify predictive variables for the development of “long-COVID”,
(3) to investigate whether different patterns of long-COVID MRU may be identified.

The study will be performed using the Système National des Données de Santé (SNDS), the French NHS claims data. Indeed, the SNDS database is the French NHS database providing individual anonymous information of primary and secondary care linked at individual level (data from PMSI, the French DRG-based medical information system). It currently covers more than 98% of the French population. We will include all the patients hospitalized for COVID19 between February 1st and June 30st 2020 and alive at their discharge date, and they will be followed-up during 6 months. We will develop an algorithm to distinguish patients developing long COVID from those who do not. It will be based on the use of specific treatments and specific resource use.

For the first time, our study will provide an estimation of MRU and associated costs of hospitalized COVID-19 patients. It will also provide an estimation of the rate of long COVID forms developed by hospitalized COVID patients, as well as detailed MRU and costs incurred by long COVID patients compared to patients with non-long COVID-19.

Project coordination

Manon Belhassen (PELyon)

The author of this summary is the project coordinator, who is responsible for the content of this summary. The ANR declines any responsibility as for its contents.

Partner

PELyon
HCL Hospices Civils de Lyon

Help of the ANR 77,598 euros
Beginning and duration of the scientific project: May 2021 - 12 Months

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