Economic Burden of Foodborne Illnesses Acquired in the United States.

Foodborne disease burden estimates inform public health priorities and can help the public understand disease impact. This article provides new estimates of the cost of U.S. foodborne illness. Our research updated disease modeling underlying these cost estimates with a focus on enhancing chronic sequelae modeling and enhancing uncertainty modeling. Our cost estimates were based on U.S. Centers for Disease Control and Prevention estimates of the numbers of foodborne illnesses, hospitalizations, and deaths caused by 31 known foodborne pathogens and unspecified foodborne agents. We augmented these estimates of illnesses, hospitalizations, and deaths with more detailed modeling of health outcomes, including chronic sequelae. For health outcomes, we relied on U.S. data and research where possible, supplemented by the use of non-U.S. research where necessary and scientifically appropriate. Cost estimates were developed from large insurance or hospital charge databases, public data sources, and existing literature and were adjusted to 2023 dollars. We estimated the cost of foodborne illness in the United States circa 2023 to be $75 billion. Deaths accounted for 56% and chronic outcomes for 31% of the mean cost. The costliest pathogen was nontyphoidal Salmonella at $17.1 billion followed by Campylobacter at $11.3 billion. Toxoplasma ($5.7 billion) and Listeria ($4 billion) followed due primarily to deaths and chronic outcomes from pregnancy-associated cases. Per-case cost ranged from $196 for Bacillus cereus to $4.6 million for Vibrio vulnificus. Unspecified agents accounted for 38% of the total cost of foodborne illness, but these illnesses were generally mild (per-case cost $781). These cost estimates can help inform food safety priorities. Our pathogen-specific per-case cost estimates can also help inform benefit-cost analysis required for new federal food safety regulations.

Identifying Sepsis From Foodborne Hospitalization: Incidence and Hospitalization Cost by Pathogen.

BACKGROUND: Sepsis causes a major health burden in the United States. To better understand the role of sepsis as a driver of the burden and cost of foodborne illness in the United States, we estimated the frequency and treatment cost of sepsis among US patients hospitalized with 31 pathogens commonly transmitted through food or with unspecified acute gastrointestinal illness (AGI). METHODS: Using data from the National Inpatient Sample from 2012 to 2015, we identified sepsis hospitalizations using 2 approaches-explicit ICD-9-CM codes for sepsis and a coding scheme developed by Angus that identifies sepsis using specific ICD-9-CM diagnosis codes indicating an infection plus organ failure. We examined differences in the frequency and the per-case cost of sepsis across pathogens and AGI and estimated total hospitalization costs using prior estimates of foodborne hospitalizations. RESULTS: Using Explicit Sepsis Codes, sepsis hospitalizations accounted for 4.6% of hospitalizations with a pathogen commonly transmitted through food or unspecified AGI listed as a diagnosis; this was 33.2% using Angus Sepsis Codes. The average per-case cost was $35 891 and $20 018, respectively. Applying the proportions of hospitalizations with sepsis from this study to prior estimates of the number foodborne hospitalizations, the total annual cost was $248 million annually using Explicit Sepsis Codes and $889 million using Angus Sepsis Codes. CONCLUSIONS: Sepsis is a serious complication among patients hospitalized with a foodborne pathogen infection or AGI resulting in a large burden of illness. Hospitalizations that are diagnosed using explicit sepsis codes are more severe and costly, but likely underestimate the burden of foodborne sepsis.

Cost of Hospitalizations for Leading Foodborne Pathogens in the United States: Identification by International Classification of Disease Coding and Variation by Pathogen.

Foodborne illness is a continuing public health problem in the United States. Seven pathogens-Campylobacter, Clostridium perfringens, Shiga toxin-producing Escherichia coli O157, Listeria monocytogenes, nontyphoidal Salmonella, norovirus, and Toxoplasma gondii-are estimated to cause >90% of the foodborne illnesses, hospitalizations, and deaths attributed to 31 known pathogens. The purpose of this article was to inform estimates of the cost of hospitalizations associated with these pathogens using National Inpatient Survey data from January 2012 through September 2015. The article explored two methodological issues. First, is it more appropriate to use hospitalizations identified using principal or all diagnosis codes when estimating cost? Second, should pathogen-specific or overall mean cost estimates be used? After excluding C. perfringens because of low sample size, the remaining six pathogens included in the analysis were associated with 17,102 hospital discharge records. Of these 55% have the pathogen listed as a principal diagnosis (FBP-PD), ranging from 6% for T. gondii to 68% for nontyphoidal Salmonella. The mean per-case cost of records with the pathogen listed as a secondary diagnosis (FBP-SD) was 2.7 times higher than FBP-PD. FBP-SD were also more severe than FBP-PD with longer lengths of stay, increasing loss of function, and increasing risk of mortality. Severity was the main driver of cost. We also found severity of illness and cost of hospitalizations vary by pathogen. Based on identifying cases with a pathogen in either FBP-PD or FBP-SD, we found mean per-case hospitalization cost across the six pathogens included in this study was $17,515, ranging from $11,552 for Campylobacter to $34,206 for norovirus. In summary, if only FBP-PD cases were used to estimate cost, estimates would likely underestimate hospitalization costs among those cases with a pathogen-specific diagnosis. Because these foodborne pathogens varied in severity of illness, the mean cost of hospitalizations also varied significantly by pathogen.