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Long-term healthcare resource use and cost associated with COVID-19 disease from a health system perspective. An equity-focused population-based cohort study

Abstract

SARS-CoV-2 strained Ontario’s health system, with social determinants of health (SDH) underexplored in cost analyses. We examined COVID-19 attributable healthcare resource use and costs from the Ontario health system perspective using health administrative data. We conducted a cohort study, matching 162,633 SARS-CoV-2-exposed individuals 1:1 to unexposed individuals. We calculated 10-day per-person mean attributable costs (2023 CAD) across care phases (pre-diagnosis, acute, post-acute, terminal), stratified by individual and area-level SDH. Among exposed individuals (mean age 40.4 years, 50.7% female), 6% were hospitalized, 1.3% admitted to critical care, and 2% died within 360 days. Mean (SD) person acute phase cost was $244 ($235-$253) and higher among males, recent immigrants, individuals living in low-income neighbourhoods and neighbourhoods with a higher proportion of crowded households. Extrapolating to the population level of 166,801 exposed individuals, the mean total survival-adjusted 360-day cost was $436 million. COVID-19 increased healthcare costs, disproportionately burdening marginalized communities.