Actionable Insights Newsletter

Translating research to power whole health

Issue 7    |    December 2023

The COVID-19 pandemic isn't over for everyone: the silent burden for the immunocompromised

Please be advised that the study results are confidential and cannot be shared outside the Elevance Health organization as they are currently under consideration for publication.

Though COVID-19 has become less severe for most people since the end of the pandemic, immunocompromised patients suffer from higher infection rates and a disproportionate health and economic burden.

Enterprise Analytics Core domain(s): Health equity/SDoH, cost of care, quality of care

Summary

Background
The end of the public health emergency, availability of vaccines and treatments, and general “COVID fatigue” have led to general sentiment that the morbidity and mortality associated with COVID-19 is a thing of the past. However, individuals who are immunocompromised (IC) or on an immunosuppressive treatment (IST) may still be at significant risk for poor health outcomes associated with COVID-19.

Objective
To estimate COVID-19 incidence rate and severity for an immunocompromised population and describe COVID-19-related healthcare resource utilization (HCRU) and costs.

Methods

• Among US Elevance Health commercially and Medicare Advantage insured members from the Healthcare Integrated Research Database (HIRD) from 4/1/2018 to 12/31/2022, IC patients (with ≥1 claim for an immunocompromising condition of interest or ≥2 claims for IST) and the general population comparator from HIRD Source Population (HSP) were identified.
• IC conditions of interest were cancers, transplants, primary immunodeficiency, or end-stage renal disease (ESRD).
• Continuous enrollment of ≥12 months was required in both cohorts.
• The index date was defined as day 366 of continuous enrollment for the HSP, while the first diagnosis for IC or fill date for IST, or 4/1/2020, (whichever came last) for the IC cohort.
• Patients were followed until disenrollment in the health plan, study end date, or death, whichever came first.

• Of the 25 million individuals in the HIRD, 2.9% were IC.
• The COVID-19 incidence rate was higher in the IC population (115.7 per 1,000 person-years) than in the HSP (77.8 cases per 1,000 patient-years), signifying consistently higher risk of COVID-19 infection in IC individuals compared to the HSP (Figure 1).
• The highest incidence rate (192.7 per 1,000 person-years) was seen in individuals with ESRD. Of note, the patients with ESRD were the only IC population that had more patients that qualified as low socioeconomic status (least advantageous) than high socioeconomic status.
• In 2022, only 3.7% of the HSP and 15.4% of the IC cohort were hospitalized for their first COVID-19 diagnosis. The highest hospitalization rate was in the ESRD (46.8%) cohort.
• During the Omicron variant wave of COVID-19 in the US in 2022, while the IC cohort only made up ~3% of the population, they constituted 30% (~$310 million) of the entire HIRD hospitalization costs.

Figure 1.  The post-index incidence rate of COVID-19 per 1,000 patient-years (April 1, 2020–December 31, 2022)

*The index date was defined as day 366 of continuous enrollment for the HSP, and the first diagnosis for IC or fill date for IST, or 4/1/2020, (whichever came last) for the IC cohort. Members were followed until disenrollment in the health plan, study end date, or death, whichever came first.

Key takeaways