Exploratory analysis of the potential for advanced diagnostic testing to reduce healthcare expenditures of patients hospitalized with meningitis or encephalitis

Abstract

Objective To estimate healthcare expenditures that could be impacted by advanced diagnostic testing for patients hospitalized with meningitis or encephalitis Methods Patients hospitalized with meningitis (N = 23,933) or encephalitis (N = 7,858) in the U.S. were identified in the 2010-2014 Truven Health MarketScan Commercial Claims and Encounters Database using ICD-9-CM diagnostic codes. The database included an average of 40.8 million commercially insured enrollees under age 65 per year. Clinical, demographic and healthcare utilization criteria were used to identify patient subgroups early in their episode who were at risk to have high inpatient expenditures. Healthcare expenditures of patients within each subgroup were bifurcated: those expenditures that remained five days after the patient could be classified into the subgroup versus those that had occurred previously. Results The hospitalization episode rate per 100,000 enrollee-years for meningitis was 13.0 (95% CI: 12.9-13.2) and for encephalitis was 4.3 (95% CI: 4.2-4.4

Direct economic burden of patients with autoimmune encephalitis in western China

“…Previous studies in the United States 21 – 24 reported a shorter LOS in the hospital but more inpatient costs for patients with encephalitis of all causes than patients with AE in China in the present study. The average LOS in the hospital was 10.6–15.1 days.…”

“…The reason for this difference may be as follows: patients in the LGI1/CASPR2 group had the shortest LOS in the hospital (median of 17.0 days, interquartile range [IQR] of 15.0-24.0), in agreement with a previous study indicating that LOS was significantly related to cost. 12 Previous studies in the United States [21][22][23][24] reported a shorter LOS in the hospital but more inpatient costs for patients with encephalitis of all causes than patients with AE in China in the present study. The average LOS in the hospital was 10.6-15.1 days.…”

“…The average LOS in the hospital was 10.6-15.1 days. [21][22][23][24] The median inpatient cost was $48,852 (IQR $23,831-$104,835) during 1998-2010, 21 and the mean inpatient expenditure was $60,181 (SD $130,276) during 2010-2014. 22 Specific comparisons of the disease burden of AE in American 12 and Chinese hospitals were performed (table e-1, links.lww.com/NXI/A315).…”

“…[21][22][23][24] The median inpatient cost was $48,852 (IQR $23,831-$104,835) during 1998-2010, 21 and the mean inpatient expenditure was $60,181 (SD $130,276) during 2010-2014. 22 Specific comparisons of the disease burden of AE in American 12 and Chinese hospitals were performed (table e-1, links.lww.com/NXI/A315). The total LOS was 1.6 times greater for patients in China than for patients in the United States 12 (median of 24.0 days vs median of 15.0 days per patient).…”

Metagenomics for neurological infections — expanding our imagination

“…The variable turnaround times are not due as much to technical variations in the assays but rather to staffing levels and the degree of automation, both of which will increase as these tests become more common and routine 18 . A health-care economics modelling study based on actual insurance payments (as opposed to amounts charged) for hospitalized patients with meningitis or encephalitis found that an opportunity exists for mNGS testing to be cost-effective in patients who have undergone a neurosurgical procedure, who are critically ill, who are infected with HIV or who have had a solid organ transplant given that these patients have long lengths of stay and substantial costs throughout the length of their hospitalization 78 . For example, mNGS could decrease health-care costs by diagnosing a treatable disease, as seen in a patient who had a lung transplant and was diagnosed with hepatitis E virus meningoencephalitis and whose anti-viral treatment resolved their neuroinflammatory disease and probably also spared them a liver transplant 9 .…”