Economic Burden of Inpatient Stays for Patients with Acute Bacterial Skin and Skin Structure Infections in the United States: A Retrospective Observational Analysis of Premier Hospital Admissions

Background:

The estimated cost of hospital admissions for acute bacterial skin and skin structure infection (ABSSSI) is not well known, specifically for unnecessary admissions (i.e. appropriate patients could receive outpatient treatment). This study estimates the cost of ABSSSI admissions and the cost of potentially unnecessary admissions.

Methods:

Inpatient admissions from 2011–2014 in the Premier database, representing 20% of US admissions, were assessed. Admissions for adult patients with a length of stay (LOS) ≥1 day, and a primary diagnosis of erysipelas/cellulitis, abscess, or wound infection (ICD-9 codes 035.xx, 681.xx, 682.xx, 686.xx, 958.3, or 998.5x) were included. The top 5 Medicare Severity-Diagnosis Related Groups (MS-DRGs), mean LOS, number of readmissions, and total cost were summarized to assess similarity over time. Results were also stratified by a subgroup of admissions with no Charlson comorbidity index (CCI) comorbidities. Differences in proportions or means in characteristics over the 4-year period or between patients with 0 or ≥1 CCI comorbidity were assessed using 2-sided t tests, chi-square tests or analysis of variance.

Results:

227,991 admissions were included (Table 1). The most common MS-DRG codes, LOS, readmissions, and total costs to the hospital were similar over the 4 years. The mean LOS was approximately 4 days; total cost ranged from $6,400 to $6,752, with 53% to 54% of the cost attributable to room and board. In 2014, 45% of ABSSSI admissions had no CCI comorbidities. These admissions involved younger patients with mostly commercial insurance, who were more often discharged home, had shorter LOS (3.4 vs 4.4 days), and had lower total cost ($5,439 vs $7,187) compared with admissions for patients who had ≥1 CCI comorbidity (all p values <0.01).

Conclusion:

ABSSSI admissions impose a significant economic impact on US hospitals, largely due to room and board costs. Results support the economic impact of a subgroup of patients with few comorbidities, representing less severe admissions, to be $144 million for Premier hospitals in 2014. Newer long-acting antibiotic therapies may eliminate the need for hospitalization for appropriate, low-risk patients, which could help reduce this substantial cost to US hospitals.