By Richard R. Watkins, MD, MS, FACP, FIDSA, FISAC
Synopsis: Researchers using a computational simulation model found that the current health and economic burden of long COVID already exceeds the cost of several chronic diseases and will continue to grow as COVID-19 cases increase.
Source: Bartsch SM, Chin KL, Strych U, et al. The current and future burden of long COVID in the United States. J Infect Dis. 2025;231:1581-1590.
Approximately 6% to 20% of individuals afflicted with COVID-19 will develop long COVID, which the Centers for Disease Control and Prevention (CDC) defines as one or more symptoms of COVID-19 that last longer than three months, even as other symptoms resolve. As cases of COVID-19 continue to occur across the United States, the number of people with long COVID will continue to increase. Bartsch and colleagues aimed to further elucidate the clinical and economic burden of long COVID on employers, insurers, the healthcare system, and society at large.
The study employed a computational simulation model that represented the clinical course, health effects, and associated costs of an individual with long COVID. Each person had a probability of seeking medical care, missing school days or workdays and having reduced productivity at school or work, and those aged 18-64 years had a probability of leaving the workforce because of their symptoms. The investigators measured health effects in quality-adjusted life years (QALYs) lost and disability-adjusted life years (DALYs). If the individual had multiple long COVID symptoms, then they accrued the costs for the outcome with the highest direct medical costs and productivity losses.
The investigators performed Monte Carlo simulations of 1,000 studies. In the first scenario, they simulated an individual with long COVID to determine the cost per case by sex and age. In the second scenario, they determined the current burden of long COVID in the United States and put the number of COVID-19 cases into the model for their remaining duration of long COVID symptoms. For the third scenario, they determined the potential future burden of long COVID and varied the number of COVID-19 cases in the population. The primary outcome was the cost per long COVID case and the potential cost to the U.S. population. The investigators based their calculations on the idea that the number of long COVID cases will vary in the future as some people recover and others become infected or re-infected.
In examining the burden of long COVID for individual cases, the study determined that an adult male with long COVID that lasts one year accrues average costs of $9,906 (95% uncertainty interval [UI], $2,637 to $27,386), of which $9,432 are productivity losses. This results in the loss of 0.21 QALYs and 0.08 DALYs. Productivity losses represent the largest proportion and vary by age and sex. For females with long COVID, every six-month increase in symptom duration increases costs by $5,038.
The current burden of long COVID costs society at least $2.01 billion to $6.56 billion, employers at least $1.99 billion to $6.49 billion in productivity losses, and third-party payers $21 million to $68.5 billion annually. When long COVID lasts multiple years, the resulting burden proportionally increases. For example, if symptoms last two years, the cost of long COVID would be an average of $4.02 billion to $13.12 billion, assuming a 100 per 10,000 persons incidence based on a long COVID probability of 6%. If the incidence of long COVID was 250 per 10,000 persons in year 1 and 100 per 10,000 persons in year 2, long COVID would cost $15.90 billion, accruing an average of 112,072 DALYs.
Commentary
The COVID-19 pandemic has had a profound effect on human health and society. One of the most important consequences has been the emergence of long COVID. The study by Bartsch and colleagues quantified both the current health and economic burden of long COVID in the United States as well as showing the future burden. Indeed, the economic burden of long COVID already exceeds many common health conditions like Lyme disease, carpal tunnel syndrome, and psoriasis. It is likely the investigators underestimated the burden of long COVID since they chose to base their projections on a lower estimate of the risk of developing long COVID after an acute COVID-19 infection. Furthermore, the projected burden also is likely an underestimate because they used CDC-defined symptoms of long COVID and left out other conditions associated with long COVID such as stroke, heart disease, blood vessel damage, and cognitive decline.
Third party (i.e., insurance) coverage of long COVID symptoms has been variable since the pandemic began. Many individuals unfortunately have found that their insurance policies do not cover their long COVID symptoms, leaving them with high medical bills. It is hoped that the current study will be used to help inform reimbursement and insurance coverage policies for long COVID symptoms and disability.
The study had some limitations. First, long COVID symptoms may differ based on the variant of SARS-CoV-2 that caused the infection. Second, the severity of symptoms may fluctuate over time, leading to additional costs. Finally, the investigators did not factor in the effect of multiple COVID-19 infections, which has been shown to increase the risk of developing long COVID, or the effect of vaccination.
Although the COVID-19 pandemic has officially ended, the spread of SARS-CoV-2 has not. Thus, people will continue to develop long COVID for the foreseeable future, leading to a significant burden on U.S. healthcare, businesses, third-party payers, and society overall.
Richard R. Watkins, MD, MS, FACP, FIDSA, FISAC, is Professor of Medicine, Division of Infectious Diseases, Northeast Ohio Medical University, Rootstown, OH.
Researchers using a computational simulation model found that the current health and economic burden of long COVID already exceeds the cost of several chronic diseases and will continue to grow as COVID-19 cases increase.
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