The IQVIA Institute for Human Data Science, a multinational health information technology and research company, published Shifts in Healthcare Demand, Delivery and Care During the COVID-19 Era, which utilizes longitudinal prescription data of over 4 billion prescriptions, medical claims data from CMS-1500 forms, and more, to understand how COVID-19 is impacting the healthcare system.
The report is broken up into sections that track the pandemic, explore patient use of health services, document the impact on medicine use, examine research activity for therapeutics and vaccines, and more.
Tracking the Pandemic
Based on the best public information available at the time of publication, IQVIA estimated that the modeled peak of active COVID-19 cases for the U.S. would be in early May with an estimation of 2 million confirmed cases, assuming current mitigation practices are maintained.
It should be noted that due to the fluidity of data available around COVID-19 cases, this data may have changed since publication of this report.
Furthermore, IQVIA found state-level profiles differ widely in number, timing, and rate of active cases, based on patterns of infection, to virus inactivity either through recovery or death, and social distancing practices. As of the publication of this report on April 29th, IQVIA estimated that per 100,000 population, the following states will experience these numbers of active cases:
- New York – 1,200
- New Jersey – 1,000
- Massachusetts – 700
- Louisiana – 500
- Florida – 125
- California – 100
Other significant points of note are:
- States with higher per capita testing rates will have higher positive test ratios, meaning that testing levels are still not sufficient to accurately gauge infections
- State testing levels vary widely in terms of number of tests relative to population and number of positive tests relative to the testing conducted. As of April 28, only one state tested more than 5% of their population
- No state has achieved 14 consecutive days of any of the criteria areas set forth by federal plans for reopening the country
- States with the highest mortality rate also tended to have higher utilization patterns of therapeutics associated with comorbidities
Patient Use of Health Services
Restricted movement orders issued across the country have resulted in a 70-80% reduction in the number of patient visits to doctors’ offices. However, telemedicine has offset some of these declines, as telemedicine consultations now account for 25% of consultations, as captured by insurance claims, with the highest shares in psychiatry and allergy/immunology.
The volume of lab tests has also decreased significantly as populations avoid healthcare settings for more minor concerns. Between the beginning of February to the end of March, lab tests initiated by emergency room visits fell more than 90%, while lab tests initiated by office visits and urgent care centers fell 75-80%.
It is believed that within the larger healthcare sphere, a lack of diagnostic testing will lead to delayed treatments and increased medical costs. Early signs indicate telehealth is not generating many lab orders.
Impact on Medicine Use
COVID-19’s impact on medicine use differs significantly by medicine type.
The use of drugs currently being investigated for COVID-19 treatment, including hydroxychloroquine, lopinavir + ritonavir (Kaletra), tocilizumab (Actemra) and sarilumab (Kevzara) has increased two-fold overall, with an eight-fold increase in hospitals. Note that this report did not include information on remdesivir.
Medicines used in hospitals to treat the symptoms of COVID-19, including respiratory treatments, sedatives, and pain medications, have seen increases between 100-700%.
Outside the hospital setting, 38 million more refills than normal were dispensed for chronic prescriptions in March in anticipation of restriction to access to pharmacies. However, this dynamic of stockpiling decreased after four weeks. It is unknown if this trend will resurge as social isolation measures continue. One note of interest is that between late March and early April, approximately 1 million fewer opioid prescriptions were filled than normal.
Research Activity for Therapeutics and Vaccines
At the time of publication, 182 drugs or regimens are in planned or active trials as therapeutics for COVID-19 or as vaccines. Over 900 trials are planned or underway, but 40% of those trials are not randomized, meaning results may be difficult to interpret.