COVID-19 Scan for Feb 15, 2022

High COVID hospital bills
Estrogen and COVID-19 death

Many COVID-19 patients left with bills after cost-sharing waivers expired

A large proportion of US COVID-19 patients were left with thousands of dollars of hospital bills after many health insurers stopped issuing cost-sharing waivers in early 2021, finds a study published yesterday in JAMA Network Open.

A team led by University of Michigan at Ann Arbor researchers mined the IQVIA PharMetrics Plus for Academics database for COVID-19 hospital claims for patients covered by Medicare Advantage or private insurance from Mar 1, 2020, to Mar 30, 2021.

During the study period, 15,625 COVID-19 patients were hospitalized 16,450 times. Average patient age was 67.7 years, and 51.9% were male.

Among privately insured patients, 2.2% to 8.8% of COVID-19 hospitalizations involved cost sharing for facility services from March 2020 to January 2021, then rose to 82.1% to 84.4% in February and March 2021. This proportion increased from 0.3% to 2.7% among Medicare Advantage patients from March 2020 to February 2021, then climbed to 66.1% in March 2021.

Privately insured patients had 4,926 hospitalizations, 753 (15.3%) of which involved cost sharing for facility services. Average total out-of-pocket cost was $3,998, which was positively associated with length of stay and residence in a non-Northeastern state.

Medicare Advantage patients were hospitalized 11,524 times, with 406 (3.5%) involving cost sharing for facility services. Average total out-of-pocket cost was $1,638, which was negatively associated with enrollment in a preferred provider organization and residence in a Western state, while length of stay was positively associated.

The study authors noted that, during 2020, most private and Medicare Advantage insurers waived cost sharing for COVID-19 hospitalizations but stopped the practice by August 2021, a move they said was premature in light of the ongoing pandemic.

"Findings suggest that patients could face substantial bills for COVID-19 hospitalization going forward," the researchers wrote. "While the potential size of these bills may convince a few patients to become vaccinated, it could also prompt patients to delay seeking care irrespective of vaccination status, as both the vaccinated and unvaccinated are both now subject to cost sharing."
Feb 14 JAMA Netw Open research letter


Higher estrogen in older women may lower the risk of COVID-19 death

Older women's estrogen levels may be linked to their chances of dying from COVID-19, with higher levels of the hormone seemingly protective against severe infection, according to an observational study yesterday in BMJ Open.

The study included 14,685 postmenopausal Swedish women from 50 to 80 years old who had COVID-19. Researchers divided them into three groups: (1) women with previously diagnosed breast cancer and receiving endocrine therapy (decreased estrogen levels), (2) women receiving hormone replacement therapy (increased estrogen), and (3) a control group of women not receiving either therapy.

There were 227 women in group 1 (2%), 2,535 in group 2 (17%), and 11,923 controls (81%). All were diagnosed as having COVID-19 sometime from Feb 1 to Sep 14, 2020.

The investigators found that the unadjusted odd ratios (ORs) for death following COVID-19 were 2.35 (95% confidence interval [CI], 1.51 to 3.65) for group 1 and 0.45 (95% CI, 0.34 to 0.6) for group 2, but only the adjusted OR for death remained statistically significant for group 2, with an OR of 0.47, or a slightly more than 50% reduction. Absolute risk of death was 4.6% for the control group versus 10.1% and 2.1% for the decreased and increased estrogen groups, respectively.

As reflected in numerous previous studies, age was significantly associated with the risk of dying from COVID-19, with each extra year tied to a 15% greater risk, while each coexisting medical condition increased the odds of death by 13%. 

The researchers conclude, "This study shows an association between oestrogen levels and COVID-19 death. Consequently, drugs increasing oestrogen levels may have a role in therapeutic efforts to alleviate COVID-19 severity in postmenopausal women and could be studied in randomised control trials."
Feb 14 BMJ Open study

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