Factors influencing the impact of financial toxicity on the quality of life of breast cancer patients after mastectomies.

Five years after the start of the COVID-19 pandemic and over 4 years since the United Kingdom (UK) began its vaccination roll-out, many COVID-19 patients continue to experience long-term symptoms. The long-term sequelae of SARS-CoV-2 infection is most often referred to as “long COVID” but is also known as “post COVID-19 condition”, “chronic COVID-19” and “post-acute COVID-19”. In December 2020, the National Institute for Health and Care Excellence (NICE) published guidance on the management of long COVID in the UK, in which the long-term effects were defined as new or ongoing symptoms ≥ 4 weeks after the start of acute COVID-19, and therefore encompassing both the ongoing symptomatic (from 4 weeks to up to 12 weeks) and post-COVID-19 syndrome (> 12 weeks) phases []. The symptomology is heterogeneous, including fatigue, fever/chills, brain fog, and shortness of breath, where symptoms may be a result of multiple distinct pathologic pathways [], may vary in type and severity [], experienced for varying time periods and can change over time []. Due to its diverse manifestation and lack of a gold standard approach to defining long COVID, it often remains underdiagnosed []. Data from the UK’s Office for National Statistics (ONS) from February and March 2024 showed long COVID affects 3.3% of the population in England and Scotland, equating to around 2 million people []. Although previous studies in the UK have primarily focused on the incidence of long COVID among those with severe COVID-19 infection (i.e., hospitalised patients) [–], long COVID is not confined to individuals who experienced severe acute COVID-19. Substantial burden also exists among those with mild-to-moderate infections, in which individuals can recover quickly from the acute phase of the illness, while long-term symptoms can significantly impair daily functioning and quality of life [, ]. Evidence from a UK cross-sectional survey between January and April 2022 indicated that approximately 69% of patients with mild-to-moderate acute COVID-19 developed long COVID symptoms [], challenging the assumption that mild disease equates to a lower long-term impact. Furthermore, there is a paucity of evidence on the prevalence of long COVID in those at increased risk of severe COVID-19. In efforts to maintain the protection of those most at risk, guidance published by the Joint Committee on Vaccination and Immunisation (JCVI) has informed eligibility for seasonal COVID-19 vaccinations, whereby those considered at high risk of severe COVID-19 are offered one seasonal vaccination dose, and those at highest risk are offered two doses. Individuals considered at high risk include: residents and staff of care homes for older adults, frontline health and social workers, those aged 50 years and older, those aged 5 to 49 years and in a clinical risk group, household contacts or carers of people with immunosuppression [], with those considered at the highest risk as individuals aged 75 years and older, residents of care homes for older adults, and patients aged 5 years and older with immunosuppression []. More importantly, while prior studies provided some insights on long-COVID associated costs in COVID-19 patients requiring hospitalization [–], the economic burden of community-managed long COVID in the UK remains unclear. Two studies using the UK Clinical Practice Research Datalink (CPRD) database have indicated a median primary care consultation cost of £39 and £31 in the unvaccinated group and vaccinated group with primary series, respectively [], and long COVID resulted in on average, an additional £2.44 per patient for primary care consultations []. However, those findings are based on data from the early phase of the pandemic (up to 2021), an important consideration as Omicron is associated with less severe outcomes compared to earlier variants [–], including a reduced risk of long COVID compared to the preceding variants []. The present study therefore aims to quantify all-cause HCRU, direct medical costs and transition of care in adult patients with long COVID in the primary care settings in the UK.