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      The Economic Burden of Infective Endocarditis due to Injection Drug Use in Australia: A Single Centre Study—University Hospital Geelong, Barwon Health, Victoria

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          Abstract

          Background

          Injection drug use (IDU) is a well-recognized risk factor for infective endocarditis (IE). Associated complications from IDU result in significant morbidity and mortality with substantial cost implications. The aim of this study was to determine the cost burden associated with the management of IE due to IDU (IE-IDU).

          Methods

          We used data collected prospectively on patients with a diagnosis of IE-IDU as part of the international collaboration on endocarditis (ICE). The cost of medical treatment was estimated based on diagnosis-related groups (DRG) and weighted inlier equivalent separation (WIES).

          Results

          There were 23 episodes from 21 patients in 12 years (2002 to 2014). The costing was done for 22 episodes due to data missing on 1 patient. The median age was 39 years. The gender distribution was equal. Heroin (71%) and methamphetamine (33%) were the most frequently used. 74% (17/23) required intensive care unit (ICU) admission. The median ICU length of stay (LOS) was 4 days (IQR (Interquartile range); 2 to 40 days) whilst median total hospital LOS was 40 days (IQR; 1 to 119 days). Twelve patients (52%) underwent valve replacement surgery. Mortality was 13% (3/23). The total medical cost for the 22 episodes is estimated at $1,628,359 Australian dollars (AUD). The median cost per episode was a median cost of $ 61363 AUD (IQR: $2806 to $266,357 AUD). We did not account for lost productivity and collateral costs attributed to concurrent morbidity.

          Conclusion

          Within the limitations of this small retrospective study, we report that the management of infective endocarditis caused by injection drug use can be associated with significant financial cost.

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          Most cited references22

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          Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis.

          J. S. Li, D Sexton, N Mick … (2000)
          Although the sensitivity and specificity of the Duke criteria for the diagnosis of infective endocarditis (IE) have been validated by investigators from Europe and the United States, several shortcomings of this schema remain. The Duke IE database contains records collected prospectively on >800 cases of definite and possible IE since 1984. Databases on echocardiograms and on patients with Staphylococcus aureus bacteremia at Duke University Medical Center are also maintained. Analyses of these databases, our experience with the Duke criteria in clinical practice, and analysis of the work of others have led us to propose the following modifications of the Duke schema. The category "possible IE" should be defined as having at least 1 major criterion and 1 minor criterion or 3 minor criteria. The minor criterion "echocardiogram consistent with IE but not meeting major criterion" should be eliminated, given the widespread use of transesophageal echocardiography (TEE). Bacteremia due to S. aureus should be considered a major criterion, regardless of whether the infection is nosocomially acquired or whether a removable source of infection is present. Positive Q-fever serology should be changed to a major criterion.
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            Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study.

            David R. Murdoch, G Ralph Corey, Bruno Hoen … (2009)
            We sought to provide a contemporary picture of the presentation, etiology, and outcome of infective endocarditis (IE) in a large patient cohort from multiple locations worldwide. Prospective cohort study of 2781 adults with definite IE who were admitted to 58 hospitals in 25 countries from June 1, 2000, through September 1, 2005. The median age of the cohort was 57.9 (interquartile range, 43.2-71.8) years, and 72.1% had native valve IE. Most patients (77.0%) presented early in the disease (<30 days) with few of the classic clinical hallmarks of IE. Recent health care exposure was found in one-quarter of patients. Staphylococcus aureus was the most common pathogen (31.2%). The mitral (41.1%) and aortic (37.6%) valves were infected most commonly. The following complications were common: stroke (16.9%), embolization other than stroke (22.6%), heart failure (32.3%), and intracardiac abscess (14.4%). Surgical therapy was common (48.2%), and in-hospital mortality remained high (17.7%). Prosthetic valve involvement (odds ratio, 1.47; 95% confidence interval, 1.13-1.90), increasing age (1.30; 1.17-1.46 per 10-year interval), pulmonary edema (1.79; 1.39-2.30), S aureus infection (1.54; 1.14-2.08), coagulase-negative staphylococcal infection (1.50; 1.07-2.10), mitral valve vegetation (1.34; 1.06-1.68), and paravalvular complications (2.25; 1.64-3.09) were associated with an increased risk of in-hospital death, whereas viridans streptococcal infection (0.52; 0.33-0.81) and surgery (0.61; 0.44-0.83) were associated with a decreased risk. In the early 21st century, IE is more often an acute disease, characterized by a high rate of S aureus infection. Mortality remains relatively high.
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              The contribution of injection drug use to hepatitis C virus transmission globally, regionally, and at country level: a modelling study

              Adam Trickey, Hannah Fraser, Aaron Lim … (2019)
              The World Health Organization aims to eliminate the hepatitis C virus (HCV) as a public health threat by 2030. Injecting drug use (IDU) is an important risk factor for HCV transmission, but the contribution to country-level and global epidemics is unknown. We estimated the contribution of IDU-associated risk to HCV epidemics at country and global levels. A dynamic, deterministic HCV transmission model simulated country-level HCV epidemics among people who inject drugs (PWID) and the general population. Each country’s model was calibrated using country-specific data from UN datasets and systematic reviews on the prevalence of HCV and IDU. The population attributable fraction (tPAF) of HCV transmission associated with IDU was estimated, defined here as the percentage of HCV infections prevented if additional HCV transmission due to IDU was removed between 2018–2030. The model included 88 countries (85% of the global population). The model predicted 0.2% of individuals were PWID in 2017 and 8% of prevalent HCV infections were among people who recently injected drugs. Globally, if elevated HCV transmission risk among PWID was removed, an estimated 43% (95% credibility interval [CrI]: 25%−67%), the tPAF, of incident HCV infections would be prevented from 2018–2030, varying regionally. The tPAF was higher (79%, CrI: 57%−97%) in high-income countries than low and middle-income countries (38%, CrI: 24%−64%) and was associated with the percentage of a country’s prevalent infections that are among PWID. Unsafe injecting practices among PWID contribute substantially to incident infections globally; any intervention that can reduce transmission among PWID will have a pronounced effect on country level incidence. NIHR
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                Author and article information

                Contributors
                Ohide Otome:
                ORCID: https://orcid.org/0000-0002-6883-5931
                Journal
                Journal ID (nlm-ta): Interdiscip Perspect Infect Dis
                Journal ID (iso-abbrev): Interdiscip Perspect Infect Dis
                Journal ID (publisher-id): ipid
                Title: Interdisciplinary Perspectives on Infectious Diseases
                Publisher: Hindawi
                ISSN (Print): 1687-708X
                ISSN (Electronic): 1687-7098
                Publication date Collection: 2022
                Publication date (Electronic): 16 December 2022
                Volume: 2022
                Electronic Location Identifier: 6484960
                Affiliations
                1University of Western Australia, Perth, Australia
                2SJOG Midland Public and Private Hospital, Midland, Australia
                3University Hospital Geelong, Barwon Health, Geelong, Australia
                4Deakin Biostatistics Unit, Faculty of Health, School of Medicine, Deakin University, Geelong, Australia
                5Geelong Centre for Emerging Infectious Disease (GCEID), Geelong, Australia
                Author notes

                Academic Editor: Divakar Sharma

                Author information
                https://orcid.org/0000-0002-6883-5931
                Article
                DOI: 10.1155/2022/6484960
                PMC ID: 9788891
                PubMed ID: 36570593
                SO-VID: 4336a443-e9c4-4992-98b3-584173a600a0
                Copyright © Copyright © 2022 Ohide Otome et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 5 May 2022
                Date revision received : 13 November 2022
                Date accepted : 25 November 2022
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Infectious disease & Microbiology
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology

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