Real-world healthcare resource utilization (HCRU) and costs among patients with hematologic or solid tumor malignancy (STM) with COVID-19 in a commercially insured or Medicare Advantage population.
Authors: Cunningham Dennis J , Willey Vincent J , Pizzicato Lia , Pollack Michael , Wenziger Cachet , Glasser Lisa , Teng Chia-Chen , Hirpara Sunny , Dube Christine , Verduzco Gutierrez Monica 
Published: June 2023

e18789

Background: Patients with hematologic or STM may be at increased risk for COVID-19 and severe clinical and economic outcomes. This study estimates the incidence rate (IR) of COVID-19 in patients with hematologic and STM and evaluates the associated HCRU and costs. Methods: Patients with hematologic or STM were retrospectively identified from the HealthCore Integrated Research Database between 4/1/2018 and 3/31/2022 (study end date). The first cancer diagnosis date or 4/1/2020 was set as the index date, whichever came last. Patients were enrolled in a commercial or Medicare Advantage insurance plan for 1 year prior to index and followed until disenrollment in the health plan, study end date or death, whichever came first. COVID-19 was identified through outpatient laboratory results and diagnosis codes on medical claims. IRs were calculated for COVID-19. Hospitalized patients were classified as severe (evidence of an intensive care unit stay with noninvasive high flow oxygen or invasive respiratory/cardiovascular support or discharge status of expired) or moderate (all other hospitalizations); length of stay (LOS) and inpatient costs were calculated. Those with only a COVID-related emergency room, outpatient claim or a positive outpatient COVID-19 test were classified as mild/asymptomatic. All-cause HCRU and costs were calculated for the 30 days pre/post-COVID-19 infection. Results: In total, 895,861 patients were identified with a hematologic or STM (mean age: 63 years; 48% male) and followed for 17 months on average. Prior to index, 10% of patients were on immunosuppressive treatments. During follow up, 10% of the hematologic or STM patients developed COVID-19. The overall IR was 72.9 per 1,000 patient years, with IRs of 57.4, 8.9, and 6.6 per 1,000 patient years for mild/asymptomatic, moderate, and severe COVID-19, respectively. Among the 17% of hematologic or STM patients hospitalized for COVID-19, 43% had severe infection with a mean LOS of 13 days and total cost of $43,229, while 57% had moderate infection with a LOS of 8 days and total cost of $20,046. Total mean all-cause cost among patients with hematologic or STM who developed COVID-19 increased from $3,410 pre-infection to $9,207 post-infection, which was predominately driven by increased inpatient costs post-infection. Conclusions: Among patients with hematologic or STM, the IR of mild COVID-19 was highest (49.5 per 1,000 patient years); however, those with moderate and severe COVID-19 had high costs associated with hospitalization ($20,046 and $43,229, respectively). These findings illustrate high burden of managing moderate and severe COVID-19, as well as opportunities to improve prevention and care of COVID-19 for patients with hematologic or STM for better clinical and economic outcomes.