Direct healthcare costs of selected diseases primarily or partially transmitted by water

Abstract

SUMMARYDespite US sanitation advancements, millions of waterborne disease cases occur annually, although the precise burden of disease is not well quantified. Estimating the direct healthcare cost of specific infections would be useful in prioritizing waterborne disease prevention activities. Hospitalization and outpatient visit costs per case and total US hospitalization costs for ten waterborne diseases were calculated using large healthcare claims and hospital discharge databases. The five primarily waterborne diseases in this analysis (giardiasis, cryptosporidiosis, Legionnaires' disease, otitis externa, and non-tuberculous mycobacterial infection) were responsible for over 40 000 hospitalizations at a cost of $970 million per year, including at least $430 million in hospitalization costs for Medicaid and Medicare patients. An additional 50 000 hospitalizations for campylobacteriosis, salmonellosis, shigellosis, haemolytic uraemic syndrome, and toxoplasmosis cost $860 million annually ($390 million in payments for Medicaid and Medicare patients), a portion of which can be assumed to be due to waterborne transmission.

The Burden of Pulmonary Nontuberculous Mycobacterial Disease in the United States

“…Although NTM is a relatively rare disease, the associated financial burden in the United States is substantial, particularly in the older adult population. Our 2010 national annual case and cost estimates, at 86,244 NTM cases and a total cost of $815 million, surpass those described in previous studies (15). Nearly 80% of this financial burden is attributed to high prescription medication costs, which are due in part to the generally chronic nature of this disease and associated with intensive recommended antibiotic treatment regimens of at least three antibiotics for a minimum of 12-18 months (20).…”

“…We identified two articles with relevant U.S. cost estimates, including annual inpatient and outpatient visit costs and prescription medication expenditures (15,17). For prevalence estimates, we relied on the estimates generated from our previous national NTM studies using Medicare and national survey data (1,18).…”

“…Medical care consumer price index data from the Bureau of Labor Statistics were used to adjust nominal published and estimated costs to reflect constant 2014 U.S. dollars (19). Collier and colleagues provided data on the number of medical encounters (defined as one episode of admission) and payment costs, including prescription medications, dependent on type of NTM-related medical encounter (hospitalizations vs. outpatient visits) and insurance provider (private, Medicaid, or Medicare) (15). Using these data, we estimated the proportion of inpatient versus outpatient encounters for each insurance provider.…”

“…Uninsured and alternative insurance provider (i.e., TRICARE) costs were excluded from our cost estimates owing to insufficient data. U.S. Census Bureau data from 2012 identified the distribution of primary health insurance types among state residents, and the annual national and state-specific NTM costs were calculated by weighting the generated case counts by insurance type and applying the proportional cost of hospitalizations and outpatient visits (15). These cost estimates therefore reflect only one NTM medical encounter per person per year and do not include additional costs incurred for recurrence of infection or multiple inpatient or outpatient medical encounters per person in a given year.…”

“…National direct cost estimates of NTM encounters based on health care claims and hospital discharge databases have been published, including costs of hospitalization and outpatient visits as well as prescription medications (2004)(2005)(2006)(2007) (15). However, state-specific estimates of the total NTM disease burden, including case numbers and costs, are currently lacking.…”