Assessing the risk and costs of COVID-19 in immunocompromised populations in a large United States commercial insurance health plan: the EPOCH-US Study

Abstract

Objective

To estimate the prevalence of patients with an immunocompromising condition at risk for COVID-19, estimate COVID-19 prevalence rate (PR) and incidence rate (IR) by immunocompromising condition, and describe COVID-19-related healthcare resource utilization (HCRU) and costs.

Methods

Using the Healthcare Integrated Research Database (HIRD), patients with ≥1 claim for an immunocompromising condition of interest or ≥2 claims for an immunosuppressive (IS) treatment and COVID-19 diagnosis during the infection period (1 April 2020–31 March 2022) and had ≥12 months baseline data were included. Cohorts (other than the composite cohort) were not mutually exclusive and were defined by each immunocompromising condition. Analyses were descriptive in nature.

Results

Of the 16,873,161 patients in the source population, 2.7% (n = 458,049) were immunocompromised (IC). The COVID-19 IR for the composite IC cohort during the study period was 101.3 per 1000 person-years and the PR was 13.5%. The highest IR (195.0 per 1000 person-years) and PR (20.1%) were seen in the end-stage renal disease (ESRD) cohort; the lowest IR (68.3 per 1000 person-years) and PR (9.4%) were seen in the hematologic or solid tumor malignancy cohort. Mean costs for hospitalizations associated with the first COVID-19 diagnosis were estimated at nearly $1 billion (2021 United States dollars [USD]) for 14,516 IC patients, with a mean cost of $64,029 per patient.

Conclusions

Immunocompromised populations appear to be at substantial risk of severe COVID-19 outcomes, leading to increased costs and HCRU. Effective prophylactic options are still needed for these high-risk populations as the COVID-19 landscape evolves.

PLAIN LANGUAGE SUMMARY

People who have a medical condition or take a medicine that can suppress their immune system (immunocompromised) have a high risk of getting COVID-19. Our study looked at how many immunocompromised people got COVID-19. We also looked at the costs and lengths of hospital stays for people with COVID-19. We found that 2.7% of the people in this large US population with health insurance were immunocompromised. People who were immunocompromised were more likely to get COVID-19 than people who were not immunocompromised. About 14% of the immunocompromised people in this study got COVID-19 and, of those, 24% were hospitalized. Immunocompromised patients in this study had long hospital stays and high costs associated with COVID-19. The risk of getting COVID-19 and having a severe case seemed to be highest for people with advanced kidney disease. The study results showed that COVID-19 can cause severe health issues in immunocompromised people and the use of vaccinations, medications, and other measures to prevent COVID-19 are especially important for immunocompromised people.

Keywords:

• COVID-19
• immunocompromised
• healthcare resource utilization
• epidemiology

Transparency

Declaration of financial/other relationships

C. Dube, L. Glasser, and M. Pollack are employees of AstraZeneca. M. Verduzco-Gutierrez has received honoraria and travel to give lectures related to long COVID-19. Unrelated to this work, she has been a consultant with AbbVie (consultant/advisor, speakers bureau), Merz (consultant/advisor, speakers bureau), Ipsen (grant/research, consultant/advisor, speakers bureau), Medtronic (consultant/advisor), and Piramal (speakers bureau). D. Cunningham has been a consultant/advisor for AstraZeneca. Carelon Research received funding from AstraZeneca to conduct this study. A. Ketkar, V. Willey, C. Wenziger, and C-C Teng are employees of Carelon Research (formerly HealthCore). A. Ketkar and V. Willey are shareholders of Elevance Health (formerly Anthem), which is a parent company of Carelon Research (formerly HealthCore). C. Dobie is an employee of Xcenda LLC and a consultant for AstraZeneca.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Conception/design of the study: AK, VW, MP, LG, MVG, DC; Acquisition/analysis of the data: AK, VW, CW, CCT; Interpretation of the data: All authors; Drafting of the paper or revising it critically for intellectual content: All authors; Final approval of the version to be published: All authors. All authors agree to be accountable for all aspects of the work.

Acknowledgements

Authors would like to acknowledge Andi Gundlach, PharmD, CMPP of Xcenda LLC (Carrollton, TX) for her writing and editorial assistance, which was funded by AstraZeneca.

Data availability statement

Due to contractual obligations to the data sources, these data are not permitted to be available for use by outside parties.

Additional information

Funding

This work was supported by AstraZeneca.