AMMI Canada – CACMID Annual Conference 2019

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.