Health care resource consumption and corresponding economic burden in patients with acute cardiovascular diseases during the COVID-19 pandemic period

BackgroundDuring the COVID-19 pandemic period, healthcare systems substantially reorganized their management of several diseases, including acute cardiovascular diseases (ACVD) such as heart failure, stroke, myocardial infarction, and pulmonary embolism. While previous studies have reported changes in hospitalization rates and clinical outcomes, the economic impact of the pandemic on healthcare expenditures for patients with ACVD remains poorly documented. This study aimed to quantify disruptions in healthcare utilization and reimbursement trends among patients with ACVD in France during the pandemic period (2020-2023). MethodsUsing comprehensive French healthcare reimbursement data from 2015 to 2023, this nationwide cohort study analyzed 3.9 million ACVD-related patient-years, totaling {euro}86 billion in reimbursements. A two-step approach was employed: first, a linear regression model based on pre-pandemic trends (2015-2019) was used to project expected expenditures for the years 2020-2023, adjusting for age, sex, calendar year, and comorbidities. Second, expenditures observed during the years 2020-2023 were compared with these projections to estimate potential disruptions related to the pandemic period. Analyses were stratified across 21 expenditure categories. ResultsBetween 2020 and 2023, ACVD-related healthcare expenditures exceeded expected values by {euro}2.3 billion (+6.2%), with the largest gap in 2023 ({euro}1.1 billion above projections). Notably, pre-pandemic annual expenditure growth ({euro}86-212 per patient) sharply accelerated during the pandemic period ({euro}492-1320 per patient). Excess spending was higher in males ({euro}1.4 billion), patients with severe comorbidities ([≥]3 comorbidities: {euro}1.4 billion), and in the 65,195 patients with ACVD and a history of a COVID-19-related hospitalization(s) ({euro}0.9 billion, driven primarily by short stay hospitalizations and rehabilitation care). Among non-COVID-19 ACVD patients, significant increases were observed in drug expenses, short stay hospitalizations, and hospitalizations in psychiatry. ConclusionIn France, the COVID-19 pandemic years were marked by substantial and sustained disruptions in healthcare expenditures among patients with ACVD, extending beyond care directly related to COVID-19. Excess costs were linked both to pandemic-related complications and broader systemic shifts, including increased psychiatric and rehabilitation needs. These findings have critical public health implications: they highlight the need to address ongoing healthcare system disruptions for this vulnerable population while also reinforcing vigilance in future health crises.