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. 2025 Mar;14(3):569-586.
doi: 10.1007/s40121-025-01112-7. Epub 2025 Feb 8.

Economic and Disease Burden Associated with Invasive Escherichia coli Disease in the United States

Mark A Schmidt  1   2 , Maxim Blum  3 , Judy L Donald  1 , Richard T Meenan  1 , Elvira Carrió  3 , Jan Poolman  4 , Maureen P Neary  5 , Thomas Verstraeten  3 , Jeroen Geurtsen  6
Affiliations

Economic and Disease Burden Associated with Invasive Escherichia coli Disease in the United States

Mark A Schmidt et al. Infect Dis Ther. 2025 Mar.

Abstract

Introduction: Invasive Escherichia coli disease (IED) incidence has increased over recent years among aging populations and has rising antimicrobial resistance. Here, we report on a comparative, cross-sectional, retrospective analysis of US patients with IED to quantify IED-related healthcare resource utilization (HCRU), costs, and impact on health-related quality of life (HRQoL).

Methods: This study included Kaiser Permanente Northwest (KPNW) members aged ≥ 60 years enrolled between July 2019 and January 2020. Patients were divided into three groups: Group 1 had experienced a recent IED episode (≤ 3 weeks before enrollment); Group 2 had experienced a former IED episode (13-18 months before enrollment); Group 3 was at risk with no prior history of IED. Data were collected from electronic hospital records, a patient survey, and the EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire. Mean costs were adjusted according to individual follow-up.

Results: Patient characteristics were generally consistent across Groups 1 (n = 289), 2 (n = 319), and 3 (n = 340). Inpatient hospitalization was observed in 84%, 44%, and 15% of patients in Groups 1, 2 and 3, respectively. Mean direct costs per patient (per 30-day follow-up) were $17,168, $2530, and $1094 in Groups 1, 2, and 3, respectively. Mean total costs per patient in the year following an IED episode (Group 2) were $35,034 vs. $16,163 in the at-risk Group 3. HRQoL was poor for patients with recent IED, with a mean EQ-5D-5L utility index value of 0.25 on the worst day of illness. During a 12-month follow-up period, rehospitalization rates and mean number of antibiotic prescriptions were ~ threefold higher for patients who recovered from IED vs. those at risk.

Conclusions: These data demonstrate substantial short- and long-term impacts of IED on HCRU, IED-related costs, and HRQoL. Additional research is needed to further value the impact of novel IED prevention strategies.

Keywords: Cost; Extraintestinal pathogenic Escherichia coli; Health-related quality of life; Healthcare resource utilization; Invasive Escherichia coli disease; Sepsis.

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Conflict of interest statement

Declarations. Conflict of Interest: Jeroen Geurtsen, Jan Poolman, and Maureen P. Neary were employees of Janssen, Pharmaceutical Companies of Johnson & Johnson, when the study was conducted. Elvira Carrió, Maxim Blum, and Thomas Verstraeten were employees of P95 Epidemiology and Pharmacovigilance when the study was conducted; P95 Epidemiology and Pharmacovigilance is a company that received consulting fees from Janssen, Pharmaceutical Companies of Johnson & Johnson. Judy L. Donald, Mark A. Schmidt, and Richard T. Meenan were employees of Kaiser Permanente when the study was conducted but did not receive research funding, honoraria, or financial benefits, including travel, from Janssen, Pharmaceutical Companies of Johnson & Johnson. Ethical Approval: This study was conducted in accordance with the ethical principles outlined in the Belmont report and its later amendments. The KPNW institutional review board approved this study (Federal Wide Assurance number: 00002344). To those invited to participate in the survey, KPCHR provided written information about the purpose of the study and what participation implied, and language was included within the consent form authorizing access to patient EMR data for the study team. Patients had the right to opt out or withdraw from the study at any time, without their rights or medical care being affected. Participation in the study was voluntary. For survey nonresponders, explicit consent to access EMR data was not required, as members of KPNW agree to the use of their medical records for research purposes (unless they specifically request to opt out) as part of their membership agreement. For all patients included in this analysis, personal identifiers were removed from analytic data sets, which were handled and stored in compliance with state and federal confidentiality and data protection laws.

Figures

Fig. 1
Fig. 1
EQ-5D-VAS scores by group on the day of the survey and worst day of IED illness. IED invasive Escherichia coli disease, EQ-5D-VAS EuroQol Visual Analog Scale
See this image and copyright information in PMC

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