Real-world retrospective analysis of patient characteristics, healthcare resource utilization, costs, and treatment patterns among unvaccinated adults with COVID-19 diagnosed in outpatient settings in the United States

Abstract

Aims

This retrospective analysis of the Optum Clinformatics Data Mart database evaluated US patient characteristics, healthcare resource utilization (HCRU), costs, and treatment patterns among unvaccinated adults with outpatient-diagnosed COVID-19 to quantify US economic burden.

Materials and methods

The index event was the earliest outpatient diagnosis of confirmed COVID-19 from May 1 to December 10, 2020. Patients had 12 months’ continuous enrollment before and were followed for ≥60 days after index date until insurance dis-enrollment or study end.

Results

236,589 patients had outpatient-diagnosed COVID-19 (7,692 with and 228,897 without subsequent COVID-19-related inpatient admission >48 h post-diagnosis). The median age was 51 years (≥65 years, 30.0%); 72.4% had ≥1 risk factor. Patients with versus without subsequent inpatient admission were more often male, older, Black/Hispanic, and had comorbidities/risk factors. With a median follow-up of 162 days, patients had a median of 1 COVID-19-related outpatient visit (with inpatient admission, 5 outpatient visits). Those with inpatient admission had a median of 1 COVID-19-related inpatient visit (median length of stay [LOS], 6 days), 33.3% were admitted to intensive care (median LOS, 8 days), 8.4%, 7.1%, and 13.3% received invasive mechanical ventilation, noninvasive mechanical ventilation, and supplemental oxygen, respectively; 13.5% experienced readmission. Inpatient mortality was 6.0% (0.3% for nonhospitalized patients). Antithrombotic therapy, antibiotics, corticosteroids, and remdesivir use increased among patients with inpatient admission versus without. Median total COVID-19-related non-zero medical costs were $208 for patients without inpatient admission (with inpatient admission, $39,187).

Limitations

Results reflect the circulating SARS-CoV-2 and treatment landscape during the study period. Requirements for continuous enrollment could have biased the population. Cost measurements may have included allowed (typically higher) and charge amounts.

Conclusions

Given the numbers of the US population who are still not fully vaccinated and the evolving epidemiology of the pandemic, this study provides relevant insights on real-world treatment patterns, HCRU, and the cost burden of outpatient-diagnosed COVID-19.

Keywords:

• Real-world evidence
• HCRU
• healthcare costs
• treatment patterns
• COVID-19
• SARS-CoV-2

JEL Classification Codes:

• I10
• I1
• I
• I11

Transparency

Declaration of funding

This work was supported by Pfizer Inc.

Declaration of financial/other interests

All authors are employees of Pfizer Inc and may hold stock or stock options.

Peer reviewers on this manuscript have received an honorarium from JME for their review work but have no other relevant financial relationships to disclose.

Author contributions

All authors were involved in the conception and design or analysis and interpretation of the data, the drafting of the paper or revising it critically for intellectual content, and the final approval of the version to be published. All authors agree to be accountable for all aspects of the work.

Acknowledgements

The authors thank Manuela di Fusco, Michael Benigno, Jennifer Nguyen, Joanna Atkinson, and Wajeeha Ansari, of Pfizer Inc, for their support in the study design and their contributions to this paper. Programming support and expertise were provided by Ewa Śleszyńska-Dopiera (Quanticate) and Ziphora Sam of Eliassen Group (Somerset, NJ). This study was sponsored by Pfizer Inc. Editorial/medical writing support was provided by Erin O’Keefe, PhD, and Rozena Varghese, PharmD, CMPP, of ICON plc (Blue Bell, PA), and was funded by Pfizer Inc.

Data availability statement

The data that support the findings of this study are available from the corresponding author, AMS, upon reasonable request.