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. 2018 Dec 1;22(12):1495-1504.
doi: 10.5588/ijtld.18.0260.

Number and cost of hospitalizations with principal and secondary diagnoses of tuberculosis, United States

M V Aslam  1 , K Owusu-Edusei  1 , S M Marks  1 , G R B Asay  1 , R Miramontes  1 , M Kolasa  1 , C A Winston  1 , P M Dietz  1
Affiliations

Number and cost of hospitalizations with principal and secondary diagnoses of tuberculosis, United States

M V Aslam et al. Int J Tuberc Lung Dis. .

Abstract
in English, French, Spanish

Objective: To estimate the number and cost of hospitalizations with a diagnosis of active tuberculosis (TB) disease in the United States.

Methods: We analyzed the 2014 National In-Patient Sample using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) codes to identify hospitalizations with a principal (TB-PD) or any secondary discharge (TB-SD) TB diagnosis. We used a generalized linear model with log link and gamma distribution to estimate the cost per TB-PD and TB-SD episode adjusted for patient demographics, insurer, clinical elements, and hospital characteristics.

Results: We estimated 4985 TB-PD and 6080 TB-SD hospitalizations nationwide. TB-PD adjusted averaged $16 695 per episode (95%CI $16 168-$17 221). The average for miliary/disseminated TB ($22 498, 95%CI $21 067-$23 929) or TB of the central nervous system ($28 338, 95%CI $25 836-$30 840) was significantly greater than for pulmonary TB ($14 819, 95%CI $14 284-$15 354). The most common principal diagnoses for TB-SD were septicemia (n = 965 hospitalizations), human immunodeficiency virus infection (n = 610), pneumonia (n = 565), and chronic obstructive pulmonary disease and bronchiectasis (COPD-B, n = 150). The adjusted average cost per TB-SD episode was $15 909 (95%CI $15 337-$16 481), varying between $8687 (95%CI $8337-$9036) for COPD-B and $23 335 (95%CI $21 979-$24 690) for septicemia. TB-PD cost the US health care system $123.4 million (95%CI $106.3-$140.5) and TB-SD cost $141.9 million ($128.4-$155.5), of which Medicaid/Medicare covered respectively 67.2% and 69.7%.

Conclusions: TB hospitalizations result in substantial costs within the US health care system.

OBJECTIF :: Estimer le nombre et le coût des hospitalisations liées à un diagnostic de tuberculose (TB) aux Etats-Unis.

MÉTHODE :: Analyser l’échantillon national des patients hospitalisés de 2014 et les codes de l’International Classification of Diseases, Ninth Revision (ICD-9) afin d’identifier les hospitalisations avec une TB comme diagnostic de sortie principal (TB-PD) ou secondaire (TB-SD). Nous avons utilisé un modèle linéaire généralisé avec lien de connexion et distribution gamma pour estimer le coût par épisode de TB-PD et TB-SD, ajusté aux caractéristiques des patients en termes de démographie, d’assurance, d’éléments cliniques et d’hôpital.

RÉSULTATS :: Nous avons estimé 4985 hospitalisations pour TB-PD et 6080 pour TB-SD dans tout le pays. Le coût ajusté de la TB-PD a été en moyenne de $16695 par épisode (IC95% 16168–17221). Le coût moyen d’une TB miliaire/disséminée ($22 498, IC95% 21067–23929) ou d’une TB du systéme nerveux central ($28 338, IC95% 25 836–30 840) a été significativement plus élevé que celui de la TB pulmonaire ($ 14819, IC95% 14284–15354). Les diagnostics principaux les plus fréquents de la TB-SD ont été une septicémie (n = 965 hospitalisations), une infection au virus de l’immunodéficience humaine (n = 610), une pneumonie (n = 565), et une broncho-pneumopathie chronique obstructive et une bronchectasie (BPCO-B; n = 150 hospitalisations). Le coût ajusté moyen par épisode de TB-SD a été de $15909 (IC95% 15337–16481), variant de $8687 (IC95% 8337–9036) pour les BPCO-B à $23335 (IC95% 21 979–24690) pour une septicémie. Le coût de la TB-PD dans le système de santé des Etats-Unis atteint 123,4 millions (IC95% 106,3–140,5) de dollars et celui de la TB-SD, 141,9 millions (IC95% 128,4–155,5) de dollars, dont Medicaid et Medicare a couvert 67,2% et 69,7%, respectivement.

CONCLUSION :: Les hospitalisations pour TB ont un coût substantiel en termes de services de santé au sein du système de soins de santé américain.

OBJETIVO:: Estimar el número de hospitalizaciones con un diagnóstico de tuberculosis (TB) activa y su costo en los Estados Unidos.

MÉTODOS:: Se analizó una muestra nacional de pacientes hospitalizados en el 2014, utilizando los códigos de la International Classification of Diseases, Ninth Revision (ICD-9) con el fin de reconocer las hospitalizaciones donde el diagnóstico principal de alta fue TB activa (TB-PD) y aquellas con TB activa como alguno de los diagnósticos secundarios de alta (TB-SD). Se aplicó un modelo lineal generalizado con función de enlace logarítmica y distribución con el objeto de estimar el costo por episodio de TB-PD y de TB-SD ajustado con respecto a las características demográficas, la aseguradora y las características clínicas del paciente y las características del hospital.

RESULTADOS:: Se calcularon 4985 hospitalizaciones con TB-PD y 6080 con TB-SD en todo el país. El promedio ajustado por episodio de TB-PD fue 16695 dólares (IC95% 16168–17221). El costo promedio por episodio de TB miliar o diseminada (22498 dólares; IC95% 21067–23929) o por TB del sistema nervioso central (28338 dólares; IC95% 25836–30840) fue significativamente mayor que por episodio de TB pulmonar (14819 dólares; IC95% 14284–15354). Los diagnósticos principales más frecuentes en los casos de TB-SD fueron septicemia (n = 965 hospitalizaciones), infección por el virus de la inmunodeficiencia humana (n = 610), neumonía (n = 565), enfermedad pulmonar obstructiva crónica y bronquiectasias (EPOC-B; n = 150 hospitalizaciones). El costo promedio ajustado por episodio de TB-SD fue 15909 dólares (IC95% 15337–16481) y osciló entre 8687 dólares (IC95% 8337–9036) en caso de EPOC-B y 23335 dólares (IC95% 21979–24690) en caso de septicemia. En el 2014, los casos de TB-PD costaron al sistema de salud de los Estados Unidos 123,4 millones de dólares (IC95% 106,3–140,5 millones) y los de TB-SD costaron 141,9 millones de dólares (IC95% 128,4–155,5 millones), de los cuales Medicaid cubrió el 67,2% y Medicare el 69,7%.

CONCLUSIÓN:: Las hospitalizaciones por TB originan costos considerables al sistema de salud de los Estados Unidos.

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Conflict of interest statement

Conflicts of interest: none declared.

Figures

Figure 1
Figure 1
Hospitalization episodes with TB noted as a principal or secondary diagnosis, United States, 2014 (n = 11 065).* (Source:). A) TB noted as a principal diagnosis (n = 4985); B) TB noted as any secondary diagnosis (n=6515); C) TB noted as a principal or any secondary diagnosis (n = 11 065). *Principal or any secondary diagnoses include 4985 TB-PD hospitalizations, 6080 exclusively TB-SD hospitalizations, and 435 observations with TB noted as both principal and any secondary diagnoses (classified as TB-PD in this study). ICD-9 = International Classification of Diseases, Ninth Revision; TB=tuberculosis; TB-PD=TB principal diagnosis; TB-SD=TB secondary diagnosis.
Figure 2
Figure 2
Hospitalization episodes with and without tuberculosis noted as any secondary diagnosis: unadjusted average cost per hospitalization episode, United States, 2014 (Source:). TB (ICD-9 codes 0.11.x-0.18.x), HIV infection (CCS code 5), septicemia (CCS code 2), pneumonia (CCS code 122), and COPD-B (CCS code 127) account for nearly 42% of all hospitalization episodes with TB noted as any secondary diagnosis. Hospitalizations with TB noted as any secondary diagnosis include 6080 exclusively TB-SD hospitalizations and 435 observations with TB noted as both principal and any secondary diagnoses (classified as TB-PD in this study). TB=tuberculosis; HIV=human immunodeficiency virus; COPD-B=chronic obstructive pulmonary disease and bronchiectasis; ICD-9=International Classification of Diseases, Ninth Revision; CCS=Clinical Classifications Software; TB-PD=TB principal diagnosis; TB-SD=TB secondary diagnosis.
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