Healthcare Utilisation of 282,080 Individuals with Long COVID Over Two Years: A Multiple Matched Control Cohort Analysis

Background: In the UK alone, long Covid(LC) has affected over 2 million individuals, yet health system burden is poorly characterised. Understanding healthcare utilisation will inform clinical, service and policy planning for current and future LC care.Methods: Using the British Heart Foundation/NHS England Secure Data Environment, we identified individuals ≥18 years of age, diagnosed with LC between January 2020 and January 2023, and age-, sex-, ethnicity-, deprivation-, region-, and comorbidity- matched control groups: (i)COVID only, no LC; (ii)pre-pandemic; (iii)contemporary non-COVID; and (iv)pre-LC(self-controlled, pre-COVID pandemic). Healthcare utilisation (number of consultations/visits per person: primary care (GP), secondary care (outpatient[OP], inpatient[IP] and emergency department[ED], investigations and procedures) and inflation-adjusted cost(£) were estimated for LC and control populations per month, calendar year and pandemic year for each category. Findings: 282,080 individuals(median[IQR] age 48.0[36.1, 58.9] years; female:62.4%) with LC were included between January 2020 and January 2023. The control groups were COVID only, no LC(n=1,112,370), pre-pandemic(n=1,031,285), contemporary non-COVID(n=1,118,360) and pre-LC(n=282,080). Healthcare utilisation per person (per month/year) was higher in LC than controls across GP and OP. For IP and ED, LC had higher healthcare utilisation than all controls but the COVID only, no LC group(all p<0.0001). Healthcare utilisation of the LC group increased progressively between 2020 and 2023, compared to controls. Cost per patient/year was also higher in individuals with LC(£3,350) than all control groups: pre-pandemic: £1,210(average excess cost: -£2,235 95% CI [-£2,284 -£2,187]), COVID only, no LC: £1,283(-£2,035 [-2,081 -£1,989]) and pre-LC: £870 (-£2,465 [-£2,554 -£2,376]), except for COVID and no LC: £5,961(£2,683 [£2,593 £2,774])(all p<0.0001). Interpretation: LC has been associated with substantial, persistent healthcare utilisation and cost over the last 3 years. Future funding, resources and staff for LC prevention, treatment and research must be prioritised to reduce sustained primary and secondary healthcare utilisation and costs.Funding: The British Heart Foundation Data Science Centre (grant No SP/19/3/34678, awarded to Health Data Research (HDR) UK) funded co-development (with NHS England) of the Secure Data Environment service for England, provision of linked datasets, data access, user software licences, computational usage, and data management and wrangling support, with additional contributions from the HDR UK Data and Connectivity component of the UK Government Chief Scientific Adviser’s National Core Studies programme to coordinate national COVID priority research. Consortium partner organisations funded the time of contributing data analysts, biostatisticians, epidemiologists, and clinicians. This work is part of a National Institute for Health Research (NIHR: COV-LT2-0043)-funded LC research programme (STIMULATE-ICP) with epidemiologic and mixed methods studies, including care inequalities and transferability to other LTCs and this complex intervention trial. It was also partially funded by NHS England (7130937).Declaration of Interest: No competing interest relevant to this publication.Ethical Approval: The North East - Newcastle and North Tyneside 2 research ethics committee provided ethical approval for the CVD-COVID-UK/COVID-IMPACT research programme (REC No 20/NE/0161) to access, within secure trusted research environments, unconsented, whole-population, de- identified data from electronic health records collected as part of patients’ routine healthcare.