Journal of health economics and outcomes research
Economic Burden of Post-COVID Syndrome in Germany Between 2021 and 2025: A Statutory Health Insurance Claims Data Analysis
By Gensorowsky D, Fröling E, Braegelmann K and 6 others.
Abstract
Background
Evidence on the economic burden of post-COVID syndrome in Germany remains limited. This study quantifies post-COVID-associated healthcare resource utilization (HCRU), sick leave, and costs.
Objectives
To compare HCRU, sick leave, and costs borne by the statutory health insurance (SHI) among incident pediatric and adult post-COVID patients with matched post-COVID-free controls.
Methods
This retrospective cohort study analyzed an anonymized German SHI claims database provided by GWQ ServicePlus AG. The observation period spanned October 2021 to June 2025 and included all individuals with incident COVID-19 diagnosis until September 2024. Incident post-COVID was defined as the first ICD-10-GM code (U07.4!; U09.9!) recorded ≥90 days after first COVID-19 diagnosis. Post-COVID cases were exactly matched 1:2 to post-COVID-free COVID-19 controls by calendar quarter of incident COVID-19 diagnosis, acute severity, cohort entry quarter, 5-year birth interval, sex, and Elixhauser Comorbidity Index. We estimated mean differences in HCRU, sick leave, and direct SHI-borne costs per case. Rate ratios of HCRU, sick leave, and costs per person-year were estimated using Poisson (HCRU/sick leave) and linear (costs) regression. Analyses covered 365-day, 730-day, and any follow-up period.