Author(s)
Yanhong Li, MS, Clinical Research Manager1, Joelle Y Friedman, MPA, Project Leader1, Betsy F O'Neal, BA, Economic Coordinator1, Matthew J Hohenboken, MD, PhD, Senior Director of Clinical Research2, Robert I. Griffiths, MS, ScD, Assistant Professor of Medicine3, Martin E. Stryjewski, MD, MHS, Attending4, Kevin A Schulman, MD, Professor1, Jula K Inrig, MD, Medical Instructor5, Vance G Fowler, MD, MHS, Associate Professor5, Shelby D Reed, PhD, Assistant Professor11Duke Clinical Research Institute, Durham, NC, USA; 2 Nabi Biopharmaceuticals, Rockville, MD, USA; 3 The Johns Hopkins University, Craftsbury, VT, USA; 4 Centro De Educación Médica e Investigaciones Clínicas(CEMIC), Buenos Aires, Argentina; 5 Duke University Medical Center, Durham, NC, USA
Objective: Using data from a large, multicenter, double-blind, phase III clinical trial designed to evaluate the efficacy and safety of a vaccine intended to reduce the incidence of S. aureus infection in adults with ESRD receiving hemodialysis, we examined inpatient costs, inpatient days, and mortality associated with S. aureus bloodstream and non-bloodstream infections. Methods: Inpatient bills were obtained for patients hospitalized with S. aureus infection. Clinical and laboratory data were recorded in the report form. Hospital charges were converted to costs using department-level cost-to-charge ratios derived from each hospital's Annual Medicare Cost Report. Statistics were used to report 12-week economic and clinical outcomes. Among patients with S. aureus bacteremia, those with additional sites of S. aureus infection were compared to those without using generalized linear regression models adjusting for confounders. Results: Among 89 patients hospitalized with S. aureus bacteremia, the mean inpatient cost was $19,454 (median: $13,011) over 12 weeks, representing an average of 11.9 inpatient days. Among 70 patients hospitalized with non-bloodstream S. aureus infections, the mean 12-week cost was $19,222 (median: $13,106) across a mean of 11.3 inpatient days. Twelve-week mortality was 20.2% for patients with S. aureus bacteremia and 15.7% for patients with non-bloodstream S.aureus infections. When adjusting for baseline demographics and medical history among patients with S. aureus bacteremia, those who experienced additional sites of S. aureus infection (n=33) incurred 1.43-fold higher 12-week inpatients costs compared to those without sites of S. aureus infection (p=0.0497). Inpatient days (13.5 vs. 11.0; P=0.3154) and 12-week mortality (15.15% vs. 23.21%; P=0.6569) did not significantly differ between S. aureus bacteremia patients with and without additional sites of S. aureus infection. Conclusion: S. aureus infections impose considerable economic burden in ESRD patients undergoing hemodialysis. The existence of additional sites of S. aureus infection among patients with S. aureus bacteremia increases inpatient costs.
Conference/Value in Health Info
2008-05, ISPOR 2008, Toronto, Ontario, Canada
Value in Health, Vol. 11, No. 3 (May/June 2008)
Code
PUK14
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Urinary/Kidney Disorders
