Characteristics associated with high hospital spending over 1 year among patients hospitalised for COVID-19 in the USA: a cohort study

Introduction Despite complex care needs during critical COVID-19, the associated long-term healthcare spending is poorly understood, limiting the ability of policy-makers to prioritise necessary care and plan for future medical countermeasures. Methods We conducted a retrospective cohort study of adults hospitalised with COVID-19 in the USA (April‒June 2020) using data from the national PINC AI Healthcare Database. Patients were followed for 365 days to measure hospital spending starting on the date of admission. We used a multivariable logistic model to identify characteristics associated with high spending. Results Among 73 606 patients hospitalised with COVID-19, 73% were aged ≥50 years, 51% were female, and 37% were non-Hispanic white. Mean hospital spending per patient over 90 days was US$28 712 (SD=US$48 583) and over 365 days was US$31 768 (SD=US$52 811). Patients who received care in the intensive care unit (36% vs 23% no intensive care, p<0.001), received a non-recommended COVID-19 treatment (28% vs 25% no treatment, p<0.001), had a longer length of stay (p<0.001), and had Medicare (27% vs 22% commercial, p<0.001) or Medicaid (25% vs 22% commercial, p<0.001) insurance were associated with a higher predicted probability of high hospital spending over 365 days. Patients who received recommended treatment (21% vs 25% no treatment, p<0.001) and were Hispanic and any race (24% vs 26% non-Hispanic white, p<0.001), non-Hispanic Asian (25% vs 26% non-Hispanic white, p=0.011), ‘other’ or unknown race and ethnicity (24% vs 26% non-Hispanic white, p<0.001), or female (25% vs 26% male, p<0.001) were associated with a lower predicted probability of high hospital spending. Conclusions Most hospital spending incurred over 1 year was for care within 90 days of admission. Patients receiving complex care or non-recommended treatments were associated with higher spending, while those receiving recommended treatments were associated with lower spending. These findings can inform pandemic preparedness planning.