July 23, 2014
In solid organ transplant recipients, a consultation with an infectious disease specialist increased the length of stay and hospitalization costs, but it also decreased mortality and reduced the rate of rehospitalization, researchers from the University of Toronto have found.
“In this era of cost-containment, the role of a specialist needs to be carefully weighed against not only the associated incremental costs, but the clinical and future economic benefits of specialized care,” the researchers wrote in Clinical Infectious Diseases. “Future studies may focus on the cost-effectiveness of such strategies which from our results may improve patient outcomes and increase current direct costs, but may be beneficial in preventing future hospitalizations.”
In this cohort study, the researchers evaluated transplant recipients who were admitted from June to September 2007, June to September 2008 and June to September 2011. The patients from 2007 and 2008 were reviewed retrospectively and the 2011 patients were reviewed prospectively. They compared survival, length of stay and direct medical costs for the patients with and without an ID consultation.
The study included 531 transplant recipients with 1,414 hospitalizations. Infection-related complications occurred in 603 hospitalization in 306 unique patients. An ID consultation was requested for 272 of the hospitalizations. In the propensity score-matched cohort, the ID consultation significantly increased the 28-day survival estimates (HR=0.33; 95% CI, 0.12-0.89), and the rehospitalization rate was lower: 16.9% vs. 23.9% for those who did not receive a consultation.
ID consultations resulted in a longer median length of stay: 7 days vs. 5 days. In addition, the costs were higher: $9,652 vs. $6,192. But among those who received an early consultation — less than 48 hours after admission — there was no significant difference in length of stay or costs.
“Infectious-related complications represent a significant burden in solid-organ transplant recipients,” the researchers wrote. “Although increased health care resource utilization was associated with those receiving infectious disease consultation, this increase was mitigated when referrals occurred within 48 hours of admission, and any infectious disease consultation was associated with lower readmission rates.”
Disclosure: The researchers report no relevant financial disclosures.