[Clinical courses and costs for hospitalizations of potentially immunocompromised COVID-19 patients in Germany].

Background:  Patients at increased risk of inadequate immune response to COVID-19 vaccinations due to their underlying disease or therapy are potentially vulnerable to severe COVID-19 courses. The aim is to assess the population size, clinical courses and hospitalization costs of these patients in Germany.
Methods:  This retrospective cohort study is based on extrapolations of a representative sample of statutory health insurance (SHI) claims data from 2020. Clinical COVID-19 courses, hospitalization costs and durations are compared between the insured group at increased risk for inadequate immune response to COVID-19 vaccinations (risk group) and the insured group without this risk.
Results:  There are approximately 1.82 million SHI-insured individuals in the risk group, of whom an estimated 240 000 insured individuals do not develop a humoral immune response after 3 COVID-19 vaccinations. The risk group shows higher proportions with COVID-19 (relative risk [RR] 1.21; 95 % confidence interval [95 % CI] 1.20-1.23), hospitalizations for COVID-19 (RR 3.40; 95 % CI 3.33-3.48), hospitalizations for COVID-19 with intensive care treatment (RR 1.36; 95 % CI 1.30-1.42), and mortality (RR 5.14; 95 % CI 4.97-5.33) compared with the group without risk. In addition, hospitalizations in the risk group are on average 18 % longer (15.36 days vs. 13.00 days) and 19 % more expensive (12 371 € vs. 10 410 €). Expected hospitalization costs in the risk group are four times greater than in the group without risk (4115 € vs. 1017 €).
Conclusions:  The risk group is vulnerable to COVID-19 and requires additional resources in the German hospital sector. This results in a need for further protective measures. Further studies are needed to evaluate the impact of different viral variants, active and passive immunizations, and therapies on clinical COVID-19 courses and their costs.
Competing Interests: D.H. ist Angestellter der WIG2 GmbH. M.P. ist Angestellter der ZEG GmbH. Die WIG2 GmbH und die ZEG GmbH sind Auftragnehmer der AstraZeneca GmbH. P.L.D., V.L. und F. J. sind Angestellte der AstraZeneca GmbH. F.J. besitzt Aktien der CureVac N.V. C–M.W. hat Honorare, Reise- und Forschungsunterstützung von der AstraZeneca GmbH, BioNTech SE, Gilead Sciences GmbH, GlaxoSmithKline GmbH & Co. KG und der Moderna Germany GmbH erhalten.
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