Evaluating medical and rehabilitation programs for long COVID: utilization, health outcomes, and healthcare costs

Long COVID presents a substantial and evolving challenge to individuals and health systems. Despite growing interest in interdisciplinary care models, empirical evidence on their structure, utilization, and effectiveness remains limited. This study examined the delivery and outcomes of specialized outpatient programs for long COVID in Alberta, Canada, focusing on: (a) patterns of program utilization; (b) patient-reported health outcomes; and (c) impacts on healthcare system utilization and costs.

A retrospective observational study was conducted using administrative health records, electronic medical records, and patient-reported outcome measures (PROMs) between April 2022 and September 2023. Adults (≥18 years) with persistent symptoms ≥12 weeks post-infection were included. Healthcare utilization and costs were assessed over 180-day pre- and post-enrollment periods. Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio (ICER).

Of 2819 referrals, 81% (n = 2287) were accepted. Most patients were female (68%), aged 48.2 years on average, and referred by community physicians. Site-level differences were observed in staffing models, care delivery modalities, and wait times. Following enrollment, patients reported small but statistically significant improvements in functional status and quality of life. Symptoms of depression, as measured by the PHQ-9, decreased by an average of 0.9 points (p < 0.05), though below thresholds for clinical significance. Anxiety levels, assessed by the GAD-7, did not change significantly. EQ-5D VAS scores improved by 4.6 points (p = 0.003). Modest reductions in inpatient, ambulatory, and physician service costs were observed. The ICER was $31,140 per quality-adjusted life year (QALY), approaching the Canadian cost-effectiveness threshold.

In this observational analysis, program participation was associated with small improvements in patient-reported health status and modest cost patterns. Because natural recovery, regression to the mean, and concurrent system changes may also explain these trends, the findings should be interpreted as preliminary associations rather than causal effects. Prospective controlled studies are needed to confirm effectiveness and economic value.