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Yang J, Andersen KM, Rai KK, Tritton T, Mugwagwa T, Tsang C, Reimbaeva M, McGrath LJ, Payne P, Backhouse B, Mendes D, Butfield R, Wood R, Nguyen JL. Health Care Resource Utilization and Costs Associated With COVID-19 Among Pediatrics Managed in the Community or Hospital Setting in England: A Population-based Cohort Study. Pediatr Infect Dis J 2024; 43:209-216. [PMID: 38113517 DOI: 10.1097/inf.0000000000004213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND Although COVID-19 morbidity is significantly lower in pediatrics than in adults, the risk of severe COVID-19 may still pose substantial health care resource burden. This study aimed to describe health care resource utilization (HCRU) and costs associated with COVID-19 in pediatrics 1-17 years old in England. METHODS A population-based retrospective cohort study of pediatrics with COVID-19 using Clinical Practice Research Datalink (CPRD Aurum) primary care data and, where available, linked Hospital Episode Statistics Admitted Patient Care secondary care data. HCRU and associated costs to the National Health Service were stratified by age, risk of severe COVID-19 and immunocompromised status, separately for those with and without hospitalization records (hospitalized cohort: COVID-19 diagnosis August 2020-March 2021; primary care cohort: COVID-19 diagnosis August 2020-January 2022). RESULTS This study included 564,644 patients in the primary care cohort and 60 in the hospitalized cohort. Primary care consultations were more common in those 1-4 years of age (face-to-face: 4.3%; telephone: 6.0%) compared with those 5-11 (2.0%; 2.1%) and 12-17 years of age (2.2%; 2.5%). In the hospitalized cohort, mean (SD) length of stay was longer [5.0 (5.8) days] among those 12-17 years old (n = 24) than those 1-4 [n = 15; 1.8 (0.9) days] and 5-11 years old [n = 21; 2.8 (2.1) days]. CONCLUSIONS Most pediatrics diagnosed with COVID-19 were managed in the community. However, hospitalizations were an important driver of HCRU and costs, particularly for those 12-17 years old. Our results may help optimize the management and resource allocation of COVID-19 in this population.
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Affiliation(s)
- Jingyan Yang
- From the Pfizer Inc, New York City, New York
- Institute for Social and Economic Research and Policy, Columbia University, New York City, New York
| | | | - Kiran K Rai
- Adelphi Real World, Bollington, United Kingdom
| | | | | | | | | | | | - Poppy Payne
- Adelphi Real World, Bollington, United Kingdom
| | | | | | | | - Robert Wood
- Adelphi Real World, Bollington, United Kingdom
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McGrath LJ, Moran MM, Alfred T, Reimbaeva M, Di Fusco M, Khan F, Welch VL, Malhotra D, Cane A, Lopez SMC. Clinical outcomes of COVID-19 and influenza in hospitalized children <5 years in the US. Front Pediatr 2023; 11:1261046. [PMID: 37753191 PMCID: PMC10518399 DOI: 10.3389/fped.2023.1261046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/21/2023] [Indexed: 09/28/2023] Open
Abstract
Introduction We compared hospitalization outcomes of young children hospitalized with COVID-19 to those hospitalized with influenza in the United States. Methods Patients aged 0-<5 years hospitalized with an admission diagnosis of acute COVID-19 (April 2021-March 2022) or influenza (April 2019-March 2020) were selected from the PINC AI Healthcare Database Special Release. Hospitalization outcomes included length of stay (LOS), intensive care unit (ICU) admission, oxygen supplementation, and mechanical ventilation (MV). Inverse probability of treatment weighting was used to adjust for confounders in logistic regression analyses. Results Among children hospitalized with COVID-19 (n = 4,839; median age: 0 years), 21.3% had an ICU admission, 19.6% received oxygen supplementation, 7.9% received MV support, and 0.5% died. Among children hospitalized with influenza (n = 4,349; median age: 1 year), 17.4% were admitted to the ICU, 26.7% received oxygen supplementation, 7.6% received MV support, and 0.3% died. Compared to children hospitalized with influenza, those with COVID-19 were more likely to have an ICU admission (adjusted odds ratio [aOR]: 1.34; 95% confidence interval [CI]: 1.21-1.48). However, children with COVID-19 were less likely to receive oxygen supplementation (aOR: 0.71; 95% CI: 0.64-0.78), have a prolonged LOS (aOR: 0.81; 95% CI: 0.75-0.88), or a prolonged ICU stay (aOR: 0.56; 95% CI: 0.46-0.68). The likelihood of receiving MV was similar (aOR: 0.94; 95% CI: 0.81, 1.1). Conclusions Hospitalized children with either SARS-CoV-2 or influenza had severe complications including ICU admission and oxygen supplementation. Nearly 10% received MV support. Both SARS-CoV-2 and influenza have the potential to cause severe illness in young children.
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Reyes-López A, Jimenez-Juárez RN, Salinas-Escudero G, Avilés-Robles MJ, Martínez-Valverde S, Granados-García V, Garduño-Espinosa J. Direct medical cost of COVID-19 in children hospitalized at a tertiary referral healthcare center in Mexico City. Front Public Health 2023; 11:1117906. [PMID: 37663858 PMCID: PMC10469674 DOI: 10.3389/fpubh.2023.1117906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 07/28/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction Despite the end of the COVID-19 pandemic being declared by the WHO, the economic consequences are far from over. One of these implications was the cost of inpatient care for health institutions. To date, some studies have examined the economic burden of COVID-19 in the adult population but only a few have focused on child populations. Objective To estimate the direct medical costs of COVID-19, focusing on children in Mexico. Method Data about resources consumed during hospital stays were extracted from the medical records of patients hospitalized at a Mexican tertiary healthcare institution. Other sources of information were the unit prices of inputs and the salaries of health personnel. A micro-costing methodology was used to obtain cost results by age group over different hospital areas. Data analysis was performed with descriptive statistics and regression models to evaluate the predictors of total cost. Results One hundred and ten medical records were reviewed of which 57.3% corresponded to male patients and the mean age was 7.2 years old. The estimated average cost per patient was US$5,943 (95% CI: US$4,249-7,637). When the costs of the three clinical areas were summed, only the 5-10 years old group showed a maximum cost of US$14,000. The regression analysis revealed the following factors as significant: sex, age, staying at an emergency room, having a positive bacterial culture, and having comorbidities. Discussion The cost results were somewhat similar to those reported in children from the USA, but only regarding low severity COVID-19 cases. However, comparability between these types of studies should be done with caution due to the huge differences between the healthcare systems of countries. The study cost results may help public decision-makers in budget planning and as inputs for future cost-effectiveness studies about interventions regarding COVID-19.
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Affiliation(s)
- Alfonso Reyes-López
- Center for Economic and Social Studies in Health, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | - Guillermo Salinas-Escudero
- Center for Economic and Social Studies in Health, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | - Silvia Martínez-Valverde
- Center for Economic and Social Studies in Health, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Víctor Granados-García
- Epidemiological and Health Services Research Unit Aging Area, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Juan Garduño-Espinosa
- Division of Research, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
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Pierre V, Draica F, Di Fusco M, Yang J, Nunez-Gonzalez S, Kamar J, Lopez S, Moran MM, Nguyen J, Alvarez P, Cha-Silva A, Gavaghan M, Yehoshua A, Stapleton N, Burnett H. The impact of vaccination and outpatient treatment on the economic burden of Covid-19 in the United States omicron era: a systematic literature review. J Med Econ 2023; 26:1519-1531. [PMID: 37964554 DOI: 10.1080/13696998.2023.2281882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/07/2023] [Indexed: 11/16/2023]
Abstract
AIMS To identify and synthesize evidence regarding how coronavirus disease 2019 (COVID-19) interventions, including vaccines and outpatient treatments, have impacted healthcare resource use (HCRU) and costs in the United States (US) during the Omicron era. MATERIALS AND METHODS A systematic literature review (SLR) was performed to identify articles published between 1 January 2021 and 10 March 2023 that assessed the impact of vaccination and outpatient treatment on costs and HCRU outcomes associated with COVID-19. Screening was performed by two independent researchers using predefined inclusion/exclusion criteria. RESULTS Fifty-eight unique studies were included in the SLR, of which all reported HCRU outcomes, and one reported costs. Overall, there was a significant reduction in the risk of COVID-19-related hospitalization for patients who received an original monovalent primary series vaccine plus booster dose vs. no vaccination. Moreover, receipt of a booster vaccine was associated with a lower risk of hospitalization vs. primary series vaccination. Evidence also indicated a significantly reduced risk of hospitalizations among recipients of nirmatrelvir/ritonavir (NMV/r), remdesivir, sotrovimab, and molnupiravir compared to non-recipients. Treated and/or vaccinated patients also experienced reductions in intensive care unit (ICU) admissions, length of stay, and emergency department (ED)/urgent care clinic encounters. LIMITATIONS The identified studies may not represent unique patient populations as many utilized the same regional/national data sources. Synthesis of the evidence was also limited by differences in populations, outcome definitions, and varying duration of follow-up across studies. Additionally, significant gaps, including HCRU associated with long COVID and various high-risk populations and cost data, were observed. CONCLUSIONS Despite evidence gaps, findings from the SLR highlight the significant positive impact that vaccination and outpatient treatment have had on HCRU in the US, including periods of Omicron predominance. Continued research is needed to inform clinical and policy decision-making in the US as COVID-19 continues to evolve as an endemic disease.
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Affiliation(s)
- Vicki Pierre
- Evidence Synthesis, Modeling & Communication, Evidera Inc., Bethesda, MD, USA
| | - Florin Draica
- Vaccine Clinical Research, Pfizer Inc., New York, NY, USA
| | | | - Jingyan Yang
- Vaccine Clinical Research, Pfizer Inc., New York, NY, USA
| | | | - Joanna Kamar
- Evidence Synthesis, Modeling & Communication, Evidera Inc., Bethesda, MD, USA
| | - Santiago Lopez
- Vaccine Clinical Research, Pfizer Inc., New York, NY, USA
| | - Mary M Moran
- Vaccine Clinical Research, Pfizer Inc., New York, NY, USA
| | | | - Piedad Alvarez
- Evidence Synthesis, Modeling & Communication, Evidera Inc., Bethesda, MD, USA
| | | | | | - Alon Yehoshua
- Vaccine Clinical Research, Pfizer Inc., New York, NY, USA
| | - Naomi Stapleton
- Evidence Synthesis, Modeling & Communication, Evidera Inc., Bethesda, MD, USA
| | - Heather Burnett
- Evidence Synthesis, Modeling & Communication, Evidera Inc., Bethesda, MD, USA
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Yao L, Graff JC, Aleya L, Jiao Y, Gu W, Tian G. Bring the life stages into the domain of basic and clinical pharmacology. Front Pharmacol 2022; 13:923016. [PMID: 36582531 PMCID: PMC9792989 DOI: 10.3389/fphar.2022.923016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
Completely distinct physiological conditions and immune responses exist among different human life stages. Age is not always consistent with the life stage. We proposed to incorporate the concept of the life stages into basic and clinical pharmacology, including clinical trials, drug labels, and drug usage in clinical practice. Life-stage-based medical treatment is the application of medicine according to life stages such as prepuberty, reproductive, and aging. A large number of diseases are life-stage-dependent. Many medications and therapy have shown various age effects but not been recognized as life-stage-dependent. The same dosage and drug applications used in different life stages lead to divergent outcomes. Incorporating life stages in medicine and drug usage will enhance the efficacy and precision of the medication in disease treatment.
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Affiliation(s)
- Lan Yao
- Department of Orthopedic Surgery and BME-Campbell Clinic, University of Tennessee Health Science Center, Memphis, TN, United States
| | - J. Carolyn Graff
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Lotfi Aleya
- Chrono-Environnement Laboratory, UMR CNRS 6249, Bourgogne Franche-Comté Université, Besançon Cedex, France
| | - Yan Jiao
- Department of Orthopedic Surgery and BME-Campbell Clinic, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Weikuan Gu
- Department of Orthopedic Surgery and BME-Campbell Clinic, University of Tennessee Health Science Center, Memphis, TN, United States,Research Service, Memphis VA Medical Center, Memphis, TN, United States,Department of Pharmaceutical Sciences, University of Tennessee Health Science Center, Memphis, TN, United States,*Correspondence: Weikuan Gu,
| | - Geng Tian
- Shandong Technology Innovation Center of Molecular Targeting and Intelligent Diagnosis and Treatment, Binzhou Medical University, Yantai, Shandong, China
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Wiemken TL, McGrath LJ, Andersen KM, Khan F, Malhotra D, Alfred T, Nguyen JL, Puzniak L, Thoburn E, Jodar L, McLaughlin JM. Coronavirus Disease 2019 Severity and Risk of Subsequent Cardiovascular Events. Clin Infect Dis 2022; 76:e42-e50. [PMID: 35984816 PMCID: PMC9907540 DOI: 10.1093/cid/ciac661] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/03/2022] [Accepted: 08/12/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Little is known about the relationship between coronavirus disease 2019 (COVID-19) severity and subsequent risk of experiencing a cardiovascular event (CVE) after COVID-19 recovery. We evaluated this relationship in a large cohort of United States adults. METHODS Using a claims database, we performed a retrospective cohort study of adults diagnosed with COVID-19 between 1 April 2020 and 31 May 2021. We evaluated the association between COVID-19 severity and risk of CVE >30 days after COVID-19 diagnosis using inverse probability of treatment-weighted competing risks regression. Severity was based on level of care required for COVID-19 treatment: intensive care unit (ICU) admission, non-ICU hospitalization, or outpatient care only. RESULTS A total of 1 357 518 COVID-19 patients were included (2% ICU, 3% non-ICU hospitalization, and 95% outpatient only). Compared to outpatients, there was an increased risk of any CVE for patients requiring ICU admission (adjusted hazard ratio [aHR], 1.80 [95% confidence interval {CI}, 1.71-1.89]) or non-ICU hospitalization (aHR, 1.28 [95% CI, 1.24-1.33]). Risk of subsequent hospitalization for CVE was even higher (aHRs, 3.47 [95% CI, 3.20-3.76] for ICU and 1.96 [95% CI, 1.85-2.09] for non-ICU hospitalized vs outpatient only). CONCLUSIONS COVID-19 patients hospitalized or requiring critical care had a significantly higher risk of experiencing and being hospitalized for post-COVID-19 CVE than patients with milder COVID-19 who were managed solely in the outpatient setting, even after adjusting for differences between these groups. These findings underscore the continued importance of preventing severe acute respiratory syndrome coronavirus 2 infection from progressing to severe illness to reduce potential long-term cardiovascular complications.
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Affiliation(s)
- Timothy L Wiemken
- Correspondence: T. L. Wiemken, Pfizer Inc, 500 Arcola Rd, Collegeville, PA 19426 ()
| | | | | | - Farid Khan
- Pfizer Inc, Collegeville, Pennsylvania, USA
| | | | | | | | | | | | - Luis Jodar
- Pfizer Inc, Collegeville, Pennsylvania, USA
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Alimohamadi Y, Yekta EM, Sepandi M, Sharafoddin M, Arshadi M, Hesari E. Hospital length of stay for COVID-19 patients: a systematic review and meta-analysis. Multidiscip Respir Med 2022; 17:856. [PMID: 36117876 PMCID: PMC9472334 DOI: 10.4081/mrm.2022.856] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/13/2022] [Indexed: 01/09/2023] Open
Abstract
The length of stay in the hospital for COVID-19 can aid in understanding the disease's prognosis. Thus, the goal of this study was to collectively estimate the hospital length of stay (LoS) in COVID-19 hospitalized individuals. To locate related studies, international databases (including Google Scholar, Science Direct, PubMed, and Scopus) were searched. The I2 index, the Cochran Q test, and T2 were used to analyze study heterogeneity. The mean LoS in COVID- 19 hospitalized patients was estimated using a random-effects model. COVID-19's total pooled estimated hospital LoS was 15.35, 95%CI:13.47-17.23; p<0.001, I2 = 80.0). South America had the highest pooled estimated hospital LoS of COVID-19 among the continents, at 20.85 (95%CI: 14.80-26.91; p<0.001, I2 = 0.01), whereas Africa had the lowest at 8.56 8 (95%CI: 1.00-22.76). The >60 age group had the highest pooled estimated COVID-19 hospital LoS of 16.60 (95%CI: 12.94-20.25; p<0.001, I2 = 82.6), while the 40 age group had the lowest hospital LoS of 10.15 (95% CI: 4.90-15.39, p<0.001, I2 = 22.1). The metanalysis revealed that COVID-19's hospital LoS was more than 10 days. However, it appears that this duration varies depending on a number of factors, including the patient's age and the availability of resources.
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Affiliation(s)
- Yousef Alimohamadi
- Exercise Physiology Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran
| | - Elahe Mansouri Yekta
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Science, Tehran, Iran
| | - Mojtaba Sepandi
- Exercise Physiology Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran
| | - Maedeh Sharafoddin
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Science, Tehran, Iran
| | - Maedeh Arshadi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Science, Tehran, Iran
| | - Elahe Hesari
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Science, Tehran, Iran
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