Clinical and cost-effectiveness of diverse post-hospitalisation pathways for COVID-19: A UK evaluation utilising the PHOSP-COVID cohort

BackgroundLong Covid has emerged as a complex health condition for millions of people worldwide following the COVID-19 pandemic. Previously, we have categorised healthcare pathways for patients after discharge from hospital with COVID-19 across 45 UK sites. The aim of this work was to estimate the clinical and cost-effectiveness of these pathways. MethodsWe examined prospectively collected data from 1,013 patients at 12-months post-discharge on whether they felt fully recovered (self-report), number of newly diagnosed conditions (NDC), quality of life (EQ-5D-5L utility score compared to pre-covid estimate) and healthcare resource costs (healthcare records). An analysis of the cost-effectiveness was performed by combining the healthcare resource cost and one-year EQ5D (giving a quality adjusted life-year: QALY) using statistical models that accounted for observed confounding. ResultsAt 1 year, 29% of participants felt fully recovered and 41% of patients had an NDC. The most comprehensive services, where all patients could potentially access assessment, rehabilitation, and mental health services, were more clinically effective when compared with either no service or light touch services (mean (SE) QALY 0.789 (0.012) vs 0.725 (0.026)), with an estimated cost per QALY of {pound}1,700 (95% uncertainty interval: dominated to {pound}24,800). ConclusionOur analysis supports the need for proactive, stratified, comprehensive follow-up for adults after hospitalisation with COVID-19 showing these services are likely to be both clinically and cost-effective according to commonly accepted thresholds.