COVID-19-Related Healthcare Utilization and Costs in a Large Insured US Population, 2021-2025.

Abstract

Comprehensive understanding of the economic impacts of COVID-19 over time remains limited, with recent estimates lacking both broad population coverage and detailed assessment of disease severity. To provide updated estimates on healthcare utilization and costs associated with COVID-19 during both pandemic and post-pandemic periods using administrative claims data. This retrospective observational study used administrative medical claims data in the USA from the Merative™ MarketScan^® databases to evaluate healthcare utilization and costs across various settings: outpatient, inpatient without intensive care unit (ICU) use, inpatient with ICU but without ventilation, and inpatient with both ICU and ventilation. The study population included enrollees with COVID-19-related medical encounters from July 2021 through June 2025. The period from July 2021 to June 2023 was classified as the pandemic period, and July 2023 to June 2025 as the post-pandemic period. Outcome measures included hospitalization and outpatient case rates, frequency of ICU admissions and ventilation utilization, mean hospital lengths of stay, and direct medical costs (reported in 2025 USD). From July 2021 to June 2025, approximately 64,000 COVID-19-related hospitalizations and 4.2 million outpatient cases were identified based on primary diagnoses. Hospitalization rates ranged from 3.0 to 1037.8 per 100,000 enrollee-years, and outpatient rates ranged from 10.4 to 122.1 per 1000 enrollee-years, peaking in early 2022 and declining thereafter with seasonal fluctuations. Hospitalization rates decreased across all age groups, although adults aged ≥ 65 years maintained the highest burden (312.6 per 100,000 enrollee-years in July 2024-June 2025). Mean length of stay and hospitalization costs declined across most adult groups, particularly for ICU-related cases. In the post-pandemic period, mean hospitalization costs ranged from $16,149 to $213,740 with a mean length of stay from 2.6 to 22.6 days. The mean outpatient costs ranged from $361 to $770 per case. Nationally, annual direct medical costs were estimated to be as high as $38.7 billion during the pandemic period and as high as $8.6 billion in 2024-2025, with adults aged ≥ 65 years accounting for approximately half of total expenditures. COVID-19 continues to impose a substantial and persistent economic burden, even in the post-pandemic period, underscoring the importance of ongoing mitigation strategies and efficient healthcare resource planning.