Clinical Risk and Outpatient Therapy Utilization for COVID-19 in the Medicare Population

Area of Science:

• Public Health
• Health Services Research
• Epidemiology

Background:

• Effective outpatient COVID-19 therapies can prevent hospitalization and death.
• Existing research shows racial and socioeconomic disparities in treatment access.
• Factors driving these disparities and their public health impact require further investigation.

Purpose of the Study:

• To evaluate COVID-19 outpatient treatment utilization within the US Medicare population.
• To simulate the impact of risk-stratified treatment allocation on severe COVID-19 outcomes.

Main Methods:

• Cross-sectional study using 2022 Medicare fee-for-service claims data.
• Analysis of outpatient COVID-19 therapy use, COVID-19 testing, ambulatory visits, and hospitalizations.
• Simulation of treatment reallocation based on a composite mortality risk score.

Main Results:

• Only 6.0% of Medicare beneficiaries received outpatient COVID-19 treatment in 2022.
• Higher-risk patients, including older adults and Black patients, received less treatment compared to lower-risk White patients.
• Reallocating treatments like nirmatrelvir to high-risk individuals could have averted 16,503 deaths.

Conclusions:

• COVID-19 outpatient treatments were disproportionately accessed by lower-risk Medicare beneficiaries.
• This suboptimal utilization limits the public health benefits of these therapies.
• Lack of clinical access or contraindications did not explain the observed undertreatment.