Healthcare Resource Utilization and Cost of Invasive Meningococcal Disease in Ontario, Canada

BACKGROUND: Invasive meningococcal disease (IMD) is associated with significant morbidity and mortality, thus remaining a concern for healthcare providers and the public. Evidence of the longitudinal burden of IMD and associated costs are scarce. Here we have evaluated the healthcare utilization and cost associated with hospitalized IMD cases in Ontario, Canada. METHODS: Observational cohort study utilizing the Ontario provincial claims databases, comprising: (1) individuals hospitalized with IMD between January 1995 and June 2012 and (2) age-, gender- and area-matched non-IMD controls (1:20 ratio). IMD cases were identified through diagnostic codes from hospitalization data and medical services claims. Costs are presented in Canadian dollars. RESULTS: Nine-hundred twelve IMD cases and 18,221 non-IMD controls were included. Over 5 years of follow-up, 27% of IMD cases (excluding initial hospitalization and 30-day acute phase) versus 15% of non-IMD controls (P < 0.001) were hospitalized. Compared with controls, IMD cases were more likely to receive alternative level of care (6.7% vs. 1.1%; P < 0.001) or visit the intensive care unit (49.2% vs. 2.4%; P < 0.001), and were associated with significantly higher mean hospitalization cost per case ($40,075 vs. $2827; P < 0.001). The hospitalization cost per case remained significantly higher when excluding the initial hospitalization and acute phase ($9867 vs. $3312; P < 0.001). The mean total cost per IMD case, including medications, hospitalization and medical services, was $45,768–$52,631 ($13,520–$23,789 excluding initial hospitalization and acute phase), for an overall cost (all cases during total follow-up) of $41,740,142–$47,999,289. CONCLUSIONS: In addition to its clinical burden, IMD is associated with significant economic burden to the public health system.