ESTIMATING THE HEALTHCARE COSTS ATTRIBUTABLE TO INVASIVE MENINGOCOCCAL DISEASE

Sunday, October 19, 2014
Poster Board # PS1-27

Beate Sander, PhD1, John Wang, MSc1, Frances Jamieson, MD2, Jeffrey Kwong, MD, MSc3, Shaun Morris, MD, MPH4, Natasha Crowcroft, PhD1, Ripudaman Minhas, MD, MPH5, Lisa Strifler, MSc6 and Shelley Deeks, MD, MHSc1, (1)Public Health Ontario, Toronto, ON, Canada, (2)Public Health Ontario Laboratories, Toronto, ON, Canada, (3)Institute for Clinical Evaluative Sciences, Toronto, ON, Canada, (4)Division of Infectious Diseases, Hospital for Sick Children, Toronto, ON, Canada, (5)Inner City Health Program at St. Michael's Hospital, Toronto, ON, Canada, (6)Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
Purpose: To estimate incidence-based healthcare costs attributable to invasive meningococcal disease (IMD) for acute illness and long-term sequelae.

Method: We conducted a retrospective matched cohort study using individually linked laboratory and health administrative data covering the Ontario, Canada, population (~13 million) to estimate healthcare costs attributable to IMD.

Subjects with IMD (“exposed” in the cohort study) were identified in the Public Health Ontario Laboratory (PHOL) dataset and individually linked to health administrative data. Unexposed subjects, randomly drawn from the general population, were hard-matched to exposed subjects (5:1) on age, sex, income quartile, rural/urban residence, and co-morbidities.

Healthcare costs for acute illness and long-term sequelae were determined by employing the phase-of-care costing approach, organizing each subject’s observation time into 3 phases: acute infection (phase 1), continuing care (phase 2), and final, pre-death phase (phase 3). Phase length was determined using the joinpoint approach and graphing costs. Costs were standardized to 10-day costs per phase (2012 Canadian dollars).

Result: From 2000 to 2010, we identified 582 subjects with IMD in the PHOL dataset and were able to link 469 to the administrative data. Exposed subjects had a mean age of 30.5 years (±26.2), 49.7% were female, 21.3% had any sequelae (85% of those had at least 1 major sequelae), 93% were hospitalized (mean length of stay 11.8±14.7 days) and 30-day mortality was 9%. Mean follow-up was 5.8 years; phase 1 length was 18 days and phase 3 length 90 days.

Mean 10-day phase 1, 2 and 3 costs (95%CI) per exposed subject were $11,325 ($9,717-$13,078), $266 ($151-$423), and $23,196 ($18,300-$28,856), respectively. Mean 10-day phase 1, 2 and 3 costs per unexposed subject were $56 ($36-$82), $57 ($47-$68), and $9,615 ($6,929-$12,359), respectively. Mean 10-day phase 1, 2 and 3 attributable costs were $11,269 ($9,679-$13,017), $209 ($97-$370), and $13,694 ($9,126-$18,914), respectively. Attributable phase 1 costs were greater for those aged ≥25 years and those with sequelae. Attributable phase 2 costs were greater for those aged ≥45 years, females, and those with sequelae.

Conclusion: IMD is associated with increases in both acute and long-term healthcare costs compared with general population controls. High quality healthcare cost data attributable to IMD is important for healthcare planning and the evaluation of prevention strategies, including novel vaccines.

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