Abstract

Objectives To investigate healthcare utilisation and cost in individuals with long COVID (LC) at population level. Design Case–control cohort analysis with multiple age-, sex-, ethnicity-, deprivation-, region- and comorbidity-matched control groups: (1) COVID only, no LC; (2) pre-pandemic; (3) contemporary non-COVID; and (4) pre-LC (self-controlled, pre-COVID pandemic). Setting National, population-based, linked UK electronic health records (British Heart Foundation/NHS England Secure Data Environment). Participants Adults aged ≥18 years with LC between January 2020 and January 2023. Main outcome measures Healthcare utilisation (number of consultations/visits per person: primary care (general practitioner [GP]), secondary care (outpatient [OP], inpatient [IP] and emergency department [ED], investigations and procedures) and inflation-adjusted cost (£) for LC and control populations per month, calendar year and pandemic year for each category. Results A total of 282,080 individuals 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, OP and ED. For IP, LC had higher healthcare utilisation than pre-LC and contemporary non-COVID (all p < 0.0001). Healthcare utilisation of the LC group increased progressively between 2020 and 2023, compared with controls. Median cost per patient/year was also higher in individuals with LC than all control groups. Conclusions LC has been associated with substantial, persistent healthcare utilisation and cost over the last three 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.