{
  "abstract": "Background Long covid has emerged as a complex health condition for millions of people worldwide following the COVID-19 pandemic. Previously, we have categorised healthcare pathways for patients after discharge from hospital with COVID-19 across 45 UK sites. The aim of this work was to estimate the clinical and cost-effectiveness of these pathways.Methods We examined prospectively collected data from 1013 patients at 12 months postdischarge on whether they felt fully recovered (self-report), number of newly diagnosed conditions (NDC), quality of life (EuroQoL-five dimension-five level (EQ-5D-5L) utility score compared with pre-COVID estimate) and healthcare resource costs (healthcare records). An analysis of the cost-effectiveness was performed by combining the healthcare resource cost and 1-year EQ-5D (giving a quality-adjusted life-year (QALY)) using statistical models that accounted for observed confounding.Results At 1 year, 29% of participants felt fully recovered, and 41% of patients had an NDC. The most comprehensive services, where all patients could potentially access assessment, rehabilitation and mental health services, were more clinically effective when compared with either no service or light touch services (mean (SE) QALY 0.789 (0.012) vs 0.725 (0.026)), with an estimated cost per QALY of £1700 (95% uncertainty interval: dominated to £24 800).Conclusion Our analysis supports the need for proactive, stratified, comprehensive follow-up, particularly assessment and rehabilitation for adults after hospitalisation with COVID-19, showing these services are likely to be both clinically and cost-effective according to commonly accepted thresholds.",
  "authors": [
    {
      "affiliations": [
        "Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK"
      ],
      "name": "Andrew H Briggs"
    },
    {
      "affiliations": [
        "Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK"
      ],
      "name": "Andrew Ibbetson"
    },
    {
      "affiliations": [
        "Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK"
      ],
      "name": "Archie Walters"
    },
    {
      "affiliations": [
        "NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, Leicester, UK"
      ],
      "name": "Linzy Houchen-Wolloff"
    },
    {
      "affiliations": [
        "Department of Population Health Sciences, University of Leicester, Leicester, UK"
      ],
      "name": "Natalie Armstrong"
    },
    {
      "affiliations": [
        "Department of Population Health Sciences, University of Leicester, Leicester, UK"
      ],
      "name": "Tristan Emerson"
    },
    {
      "affiliations": [
        "PPI Group, BBC Leicester, Leicester, UK",
        "PHOSP-COVID Patient and Public Involvement Group, Leicester NIHR Biomedical Research, Leicester, UK"
      ],
      "name": "Rhyan Gill"
    },
    {
      "affiliations": [
        "Long Covid Support, London, UK"
      ],
      "name": "Claire Hastie"
    },
    {
      "affiliations": [
        "Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton, UK"
      ],
      "name": "Paul Little"
    },
    {
      "affiliations": [
        "Department of Population Health Sciences, University of Leicester, Leicester, UK"
      ],
      "name": "Charlotte Overton"
    },
    {
      "affiliations": [
        "Healthy Minds, The Buckinghamshire IAPT Service, Oxford Health NHS Foundation Trust, Oxford, UK",
        "NIHR Oxford Health Biomedical Research Centre, Oxford Health NHS Foundation Trust, Oxford, UK"
      ],
      "name": "John Pimm"
    },
    {
      "affiliations": [
        "Asthma + Lung UK, London, UK"
      ],
      "name": "Krisnah Poinasamy"
    },
    {
      "affiliations": [
        "Cardiac/Pulmonary Rehabilitation, University Hospitals of Leicester NHS Trust, Leicester, UK",
        "Department of Respiratory Sciences, University of Leicester, Leicester, UK"
      ],
      "name": "Sally Singh"
    },
    {
      "affiliations": [
        "Asthma + Lung UK, London, UK"
      ],
      "name": "Samantha Walker"
    },
    {
      "affiliations": [
        "The Institute for Lung Health, Leicester NIHR Biomedical Research Centre Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK",
        "Division of Public Health and Epidemiology, School of Medical Sciences, University of Leicester, Leicester, UK"
      ],
      "name": "Olivia C Leavy"
    },
    {
      "affiliations": [
        "Leicester Respiratory Biomedical Research Unit, National Institute for Health Research, Leicester, UK"
      ],
      "name": "Matthew Richardson"
    },
    {
      "affiliations": [
        "NIHR Biomedical Respiratory Centre, University of Leicester, Leicester, UK",
        "The Institute for Lung Health, Leicester NIHR Biomedical Research Centre- Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK"
      ],
      "name": "Omer Elneima"
    },
    {
      "affiliations": [
        "Department of Respiratory Sciences, University of Leicester, Leicester, UK",
        "The Institute for Lung Health, Leicester NIHR Biomedical Research Centre- Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK"
      ],
      "name": "Hamish McAuley"
    },
    {
      "affiliations": [
        "The Institute for Lung Health, Leicester NIHR Biomedical Research Centre- Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK"
      ],
      "name": "Aarti Shikotra"
    },
    {
      "affiliations": [
        "The Institute for Lung Health, Leicester NIHR Biomedical Research Centre- Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK"
      ],
      "name": "Amisha Singapuri"
    },
    {
      "affiliations": [
        "The Institute for Lung Health, Leicester NIHR Biomedical Research Centre- Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK"
      ],
      "name": "Marco Sereno"
    },
    {
      "affiliations": [
        "The Institute for Lung Health, Leicester NIHR Biomedical Research Centre- Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK"
      ],
      "name": "Ruth M Saunders"
    },
    {
      "affiliations": [
        "University Hospitals of Leicester NHS Trust, Leicester, UK",
        "Respiratory, The institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK"
      ],
      "name": "Victoria C Harris"
    },
    {
      "affiliations": [
        "Respiratory Medicine, Institute for Lung Health, Leicester, UK",
        "Respiratory Sciences, University of Leicester, Leicester, UK"
      ],
      "name": "Neil J Greening"
    },
    {
      "affiliations": [
        "University of Edinburgh Centre for Medical Informatics, The Usher Institute, Edinburgh, UK"
      ],
      "name": "Ewen Harrison"
    },
    {
      "affiliations": [
        "University of Edinburgh Centre for Medical Informatics, The Usher Institute, Edinburgh, UK"
      ],
      "name": "Annemarie Docherty"
    },
    {
      "affiliations": [
        "Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK",
        "Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK"
      ],
      "name": "Nazir I Lone"
    },
    {
      "affiliations": [
        "School of Public Health, Imperial College, London, UK"
      ],
      "name": "Jennifer K Quint"
    },
    {
      "affiliations": [
        "Tayside Respiratory Research Group, University of Dundee, Dundee, UK",
        "University of Dundee, Ninewells Hospital and Medical School, Dundee, UK"
      ],
      "name": "James Chalmers"
    },
    {
      "affiliations": [
        "MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, Oxford, UK",
        "Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK"
      ],
      "name": "Ling-Pei Ho"
    },
    {
      "affiliations": [
        "Respiratory Medicine, Manchester University NHS Foundation Trust, Manchester, UK",
        "NIHR Manchester Biomedical Research Centre, Division of Infection, Inflammation and Respiratory Medicine, University of Manchester, Manchester, UK"
      ],
      "name": "Alex Robert Horsley"
    },
    {
      "affiliations": [
        "Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxfordshire, UK",
        "Oxford University Hospitals NHS Foundation Trust, Oxford, UK"
      ],
      "name": "Betty Raman"
    },
    {
      "affiliations": [
        "The Institute for Lung Health, Leicester NIHR Biomedical Research Centre Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK",
        "Division of Public Health and Epidemiology, School of Medical Sciences, University of Leicester, Leicester, UK"
      ],
      "name": "Louise V Wain"
    },
    {
      "affiliations": [
        "Department of Respiratory Sciences, University of Leicester, Leicester, UK",
        "Institute of Lung Health, University of Leicester, Leicester, UK"
      ],
      "name": "Christopher E Brightling"
    },
    {
      "affiliations": [
        "Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK",
        "Hospital for Tropical Diseases, University College Hospital London, London, UK"
      ],
      "name": "Michael Marks"
    },
    {
      "affiliations": [
        "Department of Respiratory Sciences, University of Leicester, Leicester, UK",
        "The Institute for Lung Health, Leicester NIHR Biomedical Research Centre- Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK"
      ],
      "name": "Rachael A Evans"
    },
    {
      "affiliations": [],
      "name": "PHOSP-COVID Study Collaborative Group"
    }
  ],
  "title": "Clinical and cost-effectiveness of diverse posthospitalisation pathways for COVID-19: a UK evaluation using the PHOSP-COVID cohort",
  "uid": "984b7ac5-820e-5cea-a788-c83245f162d7"
}