The economic impact of aspergillosis: analysis of hospital expenditures across patient subgroups

Objective: To measure the impact of invasive aspergillosis infection on US hospital costs and financial performance across different patient populations. Methods: Hospital discharge data for patients with a primary or secondary diagnosis of aspergillosis were extracted from the 2003 Nationwide Inpatient Sample (NIS) and the fiscal year 2003 (FYO3) Medicare Provider Analysis and Review (MedPAR) file. The data on patient demographics, length of stay (LOS), hospital charges, estimated costs, and reimbursement levels were reported. After controlling for comorbidities, operative procedures, and diagnosis-related group (DRG) assignment, the clinical and economic outcomes were compared for patients with and without aspergillosis. Results: The NIS contains a total of over 38 million projected hospital discharges. From these, 10 400 aspergillosis cases were identified across 171 DRGs, resulting in a US incidence rate of 36 per million per year. The mean age of aspergillosis patients was 55.6 years, with 53.4% mate and 67.9% Caucasian. The median (mean) LOS per aspergillosis patient was 10 (17.7) days, with a median (mean) total hospital charge (THC) of $44 845 ($96 731). Among the patient subgroups analyzed, the median (mean) THC per patient ranged from $47 252 ($82 946) for HIV to $413 200 ($442 233) for bone marrow transplant (BMT). When compared to the non-aspergillosis patient population, the data showed a significant increase in LOS, THC, and hospital costs. Furthermore, the higher hospital costs associated with aspergillosis patients were not matched by similar increases in reimbursements, resulting in a greater financial toss for hospitals. The mean reimbursement-to-cost ratio for aspergillosis, cases across the DRGs analyzed was 0.80. Conclusions: Aspergillosis affects a wide range of patient groups and has a negative economic impact across many DRGs. Improved prevention, diagnosis, and patient management strategies can help mitigate these effects on hospital financial performance. (C) 2008 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.