Older age and the presence of pre-existing chronic diseases increases the chance of experiencing severe COVID-19 which can then result in hospitalisation. This study will estimate the healthcare resource use (HCRU) and associated costs in England in the management of high-risk patients during the acute infection period of diagnosed COVID-19. Both primary and secondary care costs will be included. The study will also estimate the proportion of high-risk patients known to have COVID-19 and who are hospitalised for the condition and, separately, the proportion of these hospitalised patients who are admitted to hospital critical care. The analyses will be repeated after the study population is divided into sub-groups including by age group, a history of disease which can result in a compromised immune system, the timing of COVID-19 (infection wave), and death.
It is of public health interest to understand the HCRU and costs to the National Health Service due to COVID-19 in these high-risk patients. The results will also allow an understanding of the cost-effectiveness of treatment for high risk groups with COVID-19.
This descriptive cohort study will estimate the primary and secondary healthcare resource utilisation (HCRU) and associated costs in a population with known COVID-19 (diagnosis or positive test) and at high-risk of severe disease in England. The proportion of high-risk patients with known COVID-19 who are hospitalised, and the proportion of hospitalised patients admitted to critical care, will also be estimated.
High-risk patients will be those permanently registered on CPRD for >6 months when aged >55 years, or >12 years with a CPRD or HES record of co-morbidities considered high-risk for severe COVID-19. Hospitalisations will be those recorded on the HES Admitted Patient Care file (APC). Nosocomial disease will be excluded. The Second Generation Surveillance System, CPRD and HES will provide COVID-19 infection data and ONS Death Registration Data will provide death records. HCRU will be that on CPRD and HES APC and Accident and Emergency (A&E) files, with costs from NHS Reference, Personal Social Services Research Unit and NHS Digital prescribing costs as appropriate.
All analyses will be descriptive. The population will be described in terms of demographics, HCRU in the acute phase of 29 days from diagnosis (overall and by critical care, non-critical care, A&E and primary care), and associated costs reported. The proportion of patients with known COVID-19 and at high risk of severe disease who were then hospitalised will be estimated after testing increased in September 2020. The proportion of these hospitalised patients who were then admitted to critical care will also be estimated. Both sets of analyses will be repeated in sub-groups based on age, immunosuppressed status, COVID-19 wave and death.
The study results will provide a better understanding of the HCRU and associated costs due to COVID-19 in high-risk patients which is of public health interest and will allow estimation of cost-effectiveness of treatments.
Age; sex; COVID-19 diagnosis; COVID-19 test result; COVID-19 high-risk categories including obese / overweight; pregnant; chronic kidney disease; chronic liver disease; diabetes mellitus; primary immune deficiencies; immunosuppressed state (including diseases of the spleen); immune-mediated inflammatory disorders; solid cancers; haematological diseases and stem cell transplant recipients; HIV / AIDS – where recorded; stroke / cerebrovascular disease; heart conditions; hypertension; chronic lung diseases; dementia and other neurological conditions; motor neurone disease; multiple sclerosis; Down’s syndrome; death; COVID-19 wave, healthcare resource use (admitted patient care, A&E; primary care; critical care); respiratory support (Extracorporeal Membrane Oxygenation (ECMO); invasive ventilation; non-invasive ventilation); HCRU costs.
Vishal Patel - Chief Investigator - GSK
Nick Denholm - Corresponding Applicant - Harvey Walsh Ltd
Adeola Oliyide - Collaborator - GlaxoSmithKline - UK
Daniel Gibbons - Collaborator - GlaxoSmithKline Research & Development Limited (UK)
David Heaton - Collaborator - Harvey Walsh Ltd
Gethin Griffith - Collaborator - GSK
Gillian Hall - Collaborator - Gillian Hall Epidemiology Ltd
Puneeth Mandaknallikar - Collaborator - GSK
Xiaocong Marston - Collaborator - Harvey Walsh Ltd
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;SGSS (Second Generation Surveillance System);COVID-19 Linkages