OBJECTIVES: There is a paucity of data on the long-term (i.e., post-hospital discharge) economic and clinical burden of invasive meningococcal disease (IMD) and its related complications among IMD survivors. The objective of this study was to compare health care utilization and costs between IMD survivors with and without related complications.
METHODS: We conducted a retrospective cohort analysis of the Ingenix Impact database (1997–2009). Patients with an inpatient admission for IMD (ICD-9-CM: 036.x) and continuous health plan enrollment for ≥6 months before and ≥12 months after the initial IMD hospitalization were selected. Patients were further classified based on the presence (complicated IMD) or absence (uncomplicated IMD) of a diagnosis code for relevant clinical sequelae (identified based on literature review and clinical expertise) during the 12-month follow-up period. Health care utilization and costs (in 2009 US$) incurred during the 12-month follow-up period were compared between patients in the complicated and uncomplicated IMD groups using univariate and multivariable regression analyses.
RESULTS: Among 343 IMD patients identified, stroke (14.3%), seizure (11.7%) and hearing loss (10.5%) were the most commonly observed complications, with 34.1% experiencing ≥1 complication. Significant differences in health care utilization and costs were observed, with the largest between-group difference in follow-up costs being for inpatient services (mean [95% CI]: $72,512 [$6,439] for complicated cases vs. $24,679 [$1,234] for uncomplicated IMD; P < 0.001). Large differences were also observed for rehabilitative services ($24,405 [$21,418] vs. $159 [$116]; P < 0.05) and total health care costs ($97,854 [$9,248] vs. $32,239 [$1,611]; P < 0.001). Risk of re-hospitalization following discharge from the initial IMD admission was higher among complicated IMD patients (hazard ratio = 1.69 [95% CI] = 1.04–2.74) vs. uncomplicated cases.
CONCLUSIONS: Driven mainly be the need for repeat hospitalization, the presence of serious complications in cases of IMD increased health care utilization and costs by almost 3 fold compared to uncomplicated cases during 12 months post-diagnosis.
