Real-world healthcare resource utilization and cost burden of COVID-19 in commercially insured adults at high-risk of severe disease in the US: a retrospective database analysis

BACKGROUND AND AIM: High-risk patients with COVID-19 remained at elevated risk of severe outcomes in the Omicron era, even after receiving multiple vaccine doses. We report the Omicron-era healthcare resource utilization (HCRU) and cost burden of COVID-19 among commercially insured, oral antiviral therapy-eligible patients at high risk of severe disease. METHODS: This retrospective analysis used the TriNetX Linked US database. Eligible commercially insured patients were aged ≥18 years, had a COVID-19 diagnosis between 1 July 2023 and 30 June 2024, and had ≥1 risk factor for severe COVID-19. All-cause and COVID-19-related HCRU and costs were assessed during acute (0-30 days from diagnosis) and post-acute (31 days until December 31, 2024) follow-up. RESULTS: Of the 43,487 eligible patients, 56.2% were aged ≥50 years and 85.6% had 1-5 high-risk conditions. Patients were followed for a mean of 11.4 months following COVID-19 diagnosis (acute phase, 1.0 month; post-acute phase, 10.6 months). 13,499 patients (31.0%) received treatment for COVID-19. 9.8% of patients had ≥1 all-cause inpatient general ward admission, with a mean per-patient (PP) total cost of $14,715 (acute phase, $10,833 PP; post-acute phase, $14,403 PP). 1.3% of patients had an all-cause intensive care unit (ICU) admission, with a mean PP total cost of $75,371 (acute phase, $62,882 PP; post-acute phase, $71,666 PP). Among the small number of patients requiring mechanical ventilation in the ICU, mean all-cause PP costs were $135,677 PP overall (acute phase, $106,577 PP; post-acute phase, $130,309 PP). 28.4% of patients had ≥1 all-cause emergency department visit (mean total cost, $1,434 PP; acute phase, $842 PP; post-acute phase, $1,408 PP). CONCLUSIONS: During the Omicron era, HCRU and costs remained substantial and increased with disease severity among commercially insured patients at high risk of severe COVID-19. These findings are crucial to inform economic evaluations and payer decision‑making regarding COVID‑19 antiviral therapies.