The Economic Burden of Vancomycin Resistant Enterococcus (VRE) Bacteremia: A Population-Based Matched Cohort Study

Dr. Jennie Johnstone1, Cynthia Chen1, Emily Shing1, Kwaku Adomako1, Dr. Gary Garber1, Dr. Beate Sander2
1Public Health Ontario, Toronto, ON, Canada. 2Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, ON, Canada


Objective: To evaluate the costs attributable to VRE bacteremia from the healthcare payer perspective. Methods: We conducted a population-based matched cohort study of hospitalized patients with confirmed VRE bacteremia in Ontario, Canada, between January 2009 and December 2013. Infected (i.e., exposed) subjects were identified and hard-matched to up to three unexposed subjects based on age, sex, comorbidities, admission date, rurality, neighborhood income, hospital type and pre-hospitalization resource utilization. All subjects were followed until December 31, 2017. The primary study outcomes were costs up to 1-year post index date (C$ 2014). Results: We identified 217 exposed subjects and in preliminary analysis, we matched 127 exposed to 344 unexposed subjects. In the exposed group, mean age was 62.9 years (SD 17.1), 40% were female, and common comorbidities were cancer (33%), heart disease (21%), and renal failure on hemodialysis (10%). In the unexposed group, mean age was 62.8 years (SD 16.5), 39% were female, and common comorbidities included cancer (24%), heart disease (4%) and renal failure on hemodialysis (5%). Length of stay was 63 days for exposed versus 8 days for unexposed subjects. Mortality within 30 days was 19% for exposed subjects, 68% within 1 year, and 83% within the follow-up period, versus 7%, 17% and 35% for unexposed subjects, respectively. Approximately half (53%) of exposed subjects died during index hospitalizations versus 6% of unexposed subjects. Mean cost for index hospitalization was $134,542.69 for exposed versus $10,838.46 for unexposed subjects. Mean unadjusted costs for exposed subjects at 30 days, and 1 year were $63,762.56 and $190,931.86 versus mean unadjusted costs for unexposed subjects of $17,722.31 and $51,153.35. Conclusion: VRE bacteremia is associated with increased healthcare costs, extending well beyond the index hospitalization.