Impact of the COVID-19 pandemic on mortality and health services utilization costs of patients diagnosed with lung cancer.

Introduction: Healthcare service disruptions due to the COVID-19 pandemic may have caused worse health outcomes and resulted in more expensive treatments for patients diagnosed with lung cancer in Alberta, Canada.

Methods: A population-based retrospective cohort design was used to compare 1-year survival, mortality, and health services utilization costs of patients diagnosed with lung cancer pre- (March 17^th, 2018 to March 16^th, 2019), intra- (March 17^th, 2020 to March 16^th, 2021), and post-pandemic (March 17^th, 2021 to March 16^th, 2022). Kaplan-Meier curves and Cox regressions were used for estimating survival and hazard ratios. General linear models with gamma family and log link were used for estimating health services utilization costs. All costs were converted to 2024 Canadian dollars (CA$1~US$0.74).

Results: In total, 2332, 2271, and 2408 individual patients were diagnosed with lung cancer in the pre-, intra-, and post-COVID, respectively. The survival at 365 days after diagnosis was 50%, 49%, and 51% for patients diagnosed with lung cancer pre-, intra-, and post-pandemic, respectively. Multivariate Cox regressions showed that patients diagnosed intra- and post-pandemic had a significantly (15% and 10%) higher probability of death at 1 year after diagnosis as compared to those diagnosed pre-pandemic (intra- vs. pre- HR=1.15, p=0.001 and post- vs. pre- HR=1.10, p=0.023). Patients diagnosed with lung cancer intra-pandemic had the highest health services utilization cost ($59.000) per patient per year, followed by post-pandemic ($55,510) and pre-pandemic ($51,640). Compared to pre-pandemic, the health services utilization cost intra-pandemic was 15.3% ($7,859) higher and post-pandemic was 7.5% ($3,887) higher. Although significantly higher than pre-, post-pandemic patients had a lower hazard ratio and health services utilization cost compared to intra-pandemic.

Conclusions: Lung cancer patients diagnosed during COVID-19 pandemic had significantly increased mortality and health services utilization costs compared to pre-pandemic, however, these impacts improved right post-pandemic.