Estimating the Economic Burden of Diarrhea in the United States Amongst the Privately Insured In-Patient Population Open Access

Kernohan, Alison Renee (2011)

Permanent URL: https://etd.library.emory.edu/concern/etds/6q182k630?locale=en
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Abstract

Background:
While several studies have quantified the economic burden of diarrheal disease in the
pediatric population, recent payment-based estimates for the U.S. population are rare and
often limited to a particular diarrheal illness.
Objective:
This study used the MarketScan Commercial Claims and Encounters database to estimate
the economic burden of hospitalizations due to diarrheal disease in the privately insured
population between the ages of 0 and 64.
Methods:
The sample population was isolated from the larger database using ICD-9 codes of
interest. Costs were then calculated for in-patient records hospitalized for diarrheal and
delineated into two groups: those who had a diagnosis of interest coded as their primary
diagnosis and those who had a diagnosis of interest listed as a secondary diagnosis.
Additional analyses were conducted to determine the effect of immunocompromised
status on costs, age, gender and region specific rates of hospitalization, seasonality and
length of stay.
Results:
Between 2004 and 2008 the average cost per episode was $7,926 for patients with a
primary diagnosis of diarrhea (including $7,266 in insurer payments and $660 in out of
pocket payments) and $15,541 for patients with a secondary diagnosis of diarrhea
(including $14,680 in insurer payments and $862 in out of pocket payments). Cost also
varied significantly depending on whether the patient was immunocompromised or
immunocompetent. Rates of diarrheal illness increased with age, were higher in females
over males and were highest in the South as compared to other regions.
Discussion:
While diarrheal illness is predominately a self-limiting illness, people are still being
hospitalized for treatment, significantly contributing to the domestic economic burden of
diarrheal disease. Further research is needed to quantify the cost of those over the age of
64, and cases of diarrhea that are never hospitalized.

Table of Contents

TABLE OF CONTENTS

I. INTRODUCTION ........................................................................................................1
Current Economic Estimates ........................................................................................1

II. MATERIALS AND METHODS .................................................................................2
Data source ..................................................................................................................2
Inclusion Criteria .........................................................................................................3
Cost Calculation Methodology .....................................................................................3
Secondary Analyses .....................................................................................................4

III. RESULTS .................................................................................................................6
Economic Estimates.....................................................................................................6
Population Demographics ............................................................................................8
Seasonality ................................................................................................................ 10
Immunocompromised Patients ................................................................................... 12

IV. DISCUSSION ......................................................................................................... 13
Limitations ................................................................................................................ 17

V. CONCLUSION ........................................................................................................ 18

WORKS CITED ............................................................................................................ 19

APPENDIX A: .............................................................................................................. 21
APPENDIX B: .............................................................................................................. 23
APPENDIX C: .............................................................................................................. 24

LIST OF TABLES AND FIGURES

Mean costs per case for privately insured in-patient diarrheal cases
between 2004-2008 .........................................................................................................6

Length of Stay for a case of diarrhea within the United States
between 2004-2008 ........................................................................................................7

Cost per case estimates for in-patient records with a primary diagnosis
of diarrhea by year.............................................................................................................8

Specific rates of hospitalizations primarily from diarrheal disease
between the years 2004-2008........................................................................................9

Rates of hospitalizations for diarrheal disease between the years
2004-2008.........................................................................................................................10

Mean hospital admissions involving any diagnosis of diarrhea per day
by month of admission, 2004-2008..................................................................................10

Mean hospital admissions involving a primary diagnosis of diarrhea per
day by month of admission, 2004-2008........................................................................11

Seasonality of in-patient records of diarrheal disease by average cases
per day for 2004-2008..................................................................................................11

Mean costs per case for hospitalized patients with a primary or
secondary diagnosis of diarrhea by immune status, 2004-2008...................................12

Two-sample T-tests results for immunocompromised and immunocompetent
patients with a primary or secondary diarrheal diagnosis between 2004-2008........13


APPENDICES

Health insurance status for the United States population..................................................23
Major Diagnostic Category for the sample population.....................................................25
Net Payment from Insurer................................................................................................26
Deductable Payments from Patient....................................................................................27
Copayments made by the patient.......................................................................................27
Coinsurance Payments made by the patient.......................................................................27
Certificate of Benefits and other savings to the insurer.....................................................27
Total gross cost..................................................................................................................28

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