Short-term and Long-Term Healthcare Costs Attributable to diagnosed COVID-19 in Ontario; Canada: A Population-Based Matched Cohort Study

ObjectivesEstimates of health system costs due to COVID-19, especially for long-term disability (post COVID-19 condition [PCC]) are key to health system planning, but attributable cost data remain scarce. We characterized COVID-19-attributable costs from the health system perspective. MethodsPopulation-based matched cohort study in Ontario, Canada, using health administrative data. To assign attribution to COVID-19, individuals, defined as exposed (positive SARS-CoV-2 PCR test, 01/2020-12/2020) were matched 1:1 to an unexposed individuals (01/2016-12/2018). Historical matching was used to reduce biases due to overall reductions in healthcare during the pandemic and contamination bias. The index date was defined as the first occurrence of positive SARS-CoV-2 PCR test. We used phase-of-care costing to calculate mean attributable per-person costs (2023 CAD), standardized to 10 days, during four phases of illness: pre-index date, acute care, post-acute care (suggestive of PCC), and terminal phase (stratified by early and late deaths). Finally, we estimated total costs at 360 days by combining costs with survival estimates. ResultsOf 165,838 exposed individuals, 159,817 were matched (mean age 40{+/-}20 years, 51% female). Mean (95%CI) attributable 10-day costs per person were $1 ($-4, $6) pre-index, $240 ($231, $249) during acute care, and $18 ($14, $21) during post-acute phases. During the terminal phase, mean attributable costs were $3,928 ($3,471, $4,384) for early deaths and $1,781 ($1,182, $2,380) for late deaths. Hospitalizations accounted for 42% to 100% of total costs. Compared to males, costs among females were lower during the acute care phase, but higher during the post-acute care phase. Mean cumulative per-person cost at 360 days was $2,553 ($2,348, $2,756); females had lower costs ($2,194 [$1,945, $2,446]) than males ($2,921 [$2,602, $3,241]). ConclusionsSARS-CoV-2 infection is associated with substantial long-term healthcare costs, consistent with our understanding of the PCC. Understanding phase-specific costs can inform health sector budget planning, future economic evaluations, and pandemic planning.