Managing meningococcal disease in the United States: Hospital case characteristics and costs by age.
OBJECTIVE
Meningococcal disease occurs worldwide. Approximately 1400 to 2800 cases are reported in the United States annually. The goal of this analysis was to examine hospitalized cases of meningitis and meningococcemia to identify case characteristics, resource use, and inpatient care costs.


METHODS
International Classification of Diseases-9th Revision-Clinical Modification diagnosis codes 036.0-036.9 were used to identify cases from roughly 1000 hospitals in four all payer state discharge databases. Multiyear data (1999-2001) were examined to identify demographics, admission month, health service utilization, and hospital costs by age group: infant (<1 years), children (1-10 years), adolescent (11-17 years), young adult (18-22 years), adults (23-49 years), and adults (> or =50 years). Cost estimates include accommodations, ancillary and physician services, reported in 2003 US dollars.


RESULTS
Of 1654 cases of meningococcal disease identified, meningococcemia was coded for 51%. Adults accounted for 33% of the cases. The highest rate of admissions occurred from January through March and 62% were admitted via the Emergency Department. Inpatient case fatality rate was 6.4%; 71% of those who died had meningococcemia. The mean length of stay was 9 days. Of survivors, 91% were discharged home (1% with intravenous medications and 11% with other home health-care services) while 7% required further subacute inpatient care. The average cost per hospitalization was estimated at 23,294 dollars per patient. Infants had the lowest average cost per stay (16,793 dollars) and adolescents had the highest (28,202 dollars).


CONCLUSIONS
The presence of meningococcemia results in a greater death rate, longer length of stay, and increased care costs. Meningococcal disease has substantial economic, as well as profound clinical consequences for patients of all ages.
O'Brien
Judith A
JA
Caro Research Institute, Concord, MA 01742, USA. jobrien@caroresearch.com
Caro
J Jaime
JJ
Getsios
Denis
D
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D038801:International Classification of Diseases; D007902:Length of Stay / Q000191:economics; D008297:Male; D008585:Meningitis, Meningococcal / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D022401:Meningococcal Vaccines; D008875:Middle Aged; D009345:Neisseria meningitidis; D010351:Patient Discharge / Q000191:economics; D014481:United States / Q000453:epidemiology
D022401:Meningococcal Vaccines