Costs of skin and skin structure infections due to Staphylococcus aureus: an analysis of managed-care claims.

OBJECTIVES: The incidence of skin and skin structure infections (SSSIs) due to Staphylococcus aureus (SA) is increasing. The objective of this study was to assess the costs of a treatment episode for SA-SSSIs. METHODS: This retrospective analysis used a managed-care claims database to assess the duration and costs of incident SA-SSSI episodes treated with selected antibiotics (i.v. vancomycin, oral linezolid, and daptomycin, termed 'study antibiotics'). Patients were included if they had an ICD-9-CM diagnosis of an SSSI and SA between January 1, 2002 and December 31, 2005. Treatment episodes began on the date of the first antibiotic and ended when the patient had fourteen consecutive days without a study antibiotic or SSSI hospitalization. Costs, represented by health plan payments for SSSIs and overall, were updated to 2005 US dollars. A generalized linear model (GLM) assessed predictors of costs. RESULTS: A total of 1997 patients met the selection criteria. Mean (+/- SD) age was 46.3 (+/- 12.6) years and 55.9% of patients were male. Average episode length was 24 days, and over 95% of patients received i.v. vancomycin or oral linezolid as their initial study antibiotic. Patients remained on study antibiotics for an average of 16.4 days, and only 5% of patients were switched to another study antibiotic. Mean (+/- SD) overall episode costs were $8865 (+/- $20,003), primarily composed of inpatient and outpatient medical services. Treatment failure (i.e., study antibiotic switching or hospitalization), younger age, a diagnosis of bacteremia, osteomyelitis, or multiple complications during the episode, treatment with daptomycin, and greater Charlson co-morbidity score were significant positive predictors of overall costs. Alternatively, treatment with oral linezolid and hospitalization before the start of the outpatient treatment episode were significant negative predictors of overall costs. Mean (+/- SD) SSSI-related costs were $4551 (+/- $11,058). LIMITATIONS: Medical charts and laboratory test results were not available to confirm SSSI and SA diagnoses, and no information was available regarding antibiotics received in the inpatient setting. CONCLUSIONS: The costs of treating SA-SSSIs are substantial and vary by failure rates, co-morbidities, and type of antibiotic therapy.

One-year costs of ischemic heart disease among patients with acute coronary syndromes: findings from a multi-employer claims database.

OBJECTIVE: Acute coronary syndromes (ACS) are life-threatening disorders requiring intensive medical management or invasive cardiovascular procedures. Limited data exist on the costs and resource utilization associated with ACS. METHODS: This retrospective single-cohort study analyzed administrative claims data from employer-sponsored plans for patients with an ACS hospitalization in 2001-2002. A 1-year follow-up period was used, and patients who were under age 35 or had an ACS diagnosis in the 12 months before the hospitalization were excluded. Costs were reported in 2005 US dollars. RESULTS: We identified 16,321 patients hospitalized for ACS during the study period. Mean (+/- SD) age was 55.6 (+/- 6.7) years, 66.7% were male, and 46.3% underwent a revascularization procedure during their initial hospitalization. Mean length of stay for the initial hospitalization was 4.6 days (median: 3.0; IQR: 2.0-5.0), and per-patient expenditures averaged $22,921 (median: $13,960; IQR: $6839-28 588). During the follow-up period, 21% of patients were rehospitalized for ischemic heart disease (IHD), and the cost of rehospitalization averaged $28,637. Additionally, in the year following the inpatient admission, 50% of patients were prescribed antiplatelet or anticoagulant medications, and 90% of patients were prescribed lipid-lowering, antihypertensive, or antiarrhythmic medications. IHD-related expenditures after the initial inpatient stay averaged $9425 (median: $2800; IQR: $899-7577); 61% of these costs were due to rehospitalization. Total first-year costs averaged $32,345 (median: $21,653; IQR: $10,642-41,106). LIMITATIONS: Diagnoses could not be verified through medical charts. Payments for Medicare patients were not assessed given our focus on the working-age population. CONCLUSIONS: In this employer-sponsored health plan population, the costs of inpatient and outpatient IHD-related care were high. Future studies should evaluate the impact of improved patient management on post-discharge costs.