Population-based matched cohort study of COVID-19 healthcare costs, Ontario, Canada

Estimates of COVID-19–related healthcare costs are key to health system planning, but attributable cost data remain limited. We characterized healthcare costs attributable to COVID-19 through a population-based matched cohort study in Ontario, Canada, by using health administrative data. We matched SARS-CoV-2–positive persons from 2020 to unexposed historical control persons from 2016–2018. We estimated phase-based and survival-adjusted COVID-19–attributable healthcare costs from the health system perspective. We matched 159,817 persons. Mean (95% CI) attributable 10-day costs per person were $1 ($–4 to $6) preindex, $240 ($231–$249) during acute care, $18 ($14–$21) in postacute phases, $3,928 ($3,471–$4,384) in the terminal phase for early deaths, and $1,781 ($1,182–$2,380) for late deaths. Mean cumulative survival-adjusted cost at 360 days was $2,553 ($2,348–$2,756) per person. SARS-CoV-2 infection is associated with substantial long-term healthcare costs, consistent with understanding of post-COVID condition. Determining phase-specific costs can inform budget and pandemic planning.