Volume 27, Number 1—January 2021
Research
Estimate of Burden and Direct Healthcare Cost of Infectious Waterborne Disease in the United States
Sarah A. Collier
, Li Deng, Elizabeth A. Adam, Katharine M. Benedict, Elizabeth M. Beshearse, Anna J. Blackstock, Beau B. Bruce, Gordana Derado, Chris Edens, Kathleen E. Fullerton, Julia W. Gargano, Aimee L. Geissler, Aron J. Hall, Arie H. Havelaar, Vincent R. Hill, Robert M. Hoekstra, Sujan C. Reddy, Elaine Scallan, Erin K. Stokes, Jonathan S. Yoder, and Michael J. Beach
, Li Deng, Elizabeth A. Adam, Katharine M. Benedict, Elizabeth M. Beshearse, Anna J. Blackstock, Beau B. Bruce, Gordana Derado, Chris Edens, Kathleen E. Fullerton, Julia W. Gargano, Aimee L. Geissler, Aron J. Hall, Arie H. Havelaar, Vincent R. Hill, Robert M. Hoekstra, Sujan C. Reddy, Elaine Scallan, Erin K. Stokes, Jonathan S. Yoder, and Michael J. Beach
Table 5
Total direct healthcare cost of ED visits and hospitalizations from domestically acquired waterborne transmission of selected infectious diseases, United States, 2014*
| Disease or syndrome | Value (95% CrI) |
|||||||
|---|---|---|---|---|---|---|---|---|
| Treat-and-release ED visits† |
Hospitalization |
Direct healthcare cost, millions | ||||||
| Cost per visit | Total no. visits | Total cost, millions | Cost per stay | Total no. hospital stays | Total cost, millions | |||
| Campylobacteriosis | 1,710 (137–5,810) | 319 (31–966) | 0.545 (0.0177–2.61) | 13,600 (3,850–35,800) | 2,150 (192–6,900) | 30.0 (1.71–121) | 30.5 (2.10–121) | |
| Cryptosporidiosis | 1,960 (238–6,270) | 492 (167–957) | 0.963 (0.0802–3.44) | 16,100 (4,360–55,400) | 1,120 (102–3,550) | 17.9 (1.10–79.5) | 18.9 (1.82–80.4) | |
| Giardiasis | 1,620 (196–7,510) | 567 (185–1,120) | 0.917 (0.0861–3.78) | 21,800 (6,160–99,200) | 1,100 (364–2,180) | 23.9 (3.53–104) | 24.8 (4.21–105) | |
| Legionnaires’ disease | 691 (288–1,390) | 667 (289–1,200) | 0.460 (0.127–1.13) | 37,100 (7,950–149,000) | 10,800 (7,280–13,100) | 401 (79.0–1,690) | 402 (79.5–1,690) | |
| NTM infection | 1,610 (129–6,430) | 5,080 (2,560–7,750) | 8.17 (0.584–34.0) | 29,600 (6,350–120,000) | 51,400 (26,800–74,100) | 1,520 (266–6,370) | 1,530 (272–6,380) | |
| Norovirus‡ | 1,140 | 26,300 | 30.1 | 6,080 | 4,780 | 29 | 59.1 | |
| Otitis externa | 494 (120–1,430) | 567,000 (337,000–823,000) | 280 (60.2–846) | 12,200 (3,320–42,400) | 23,200 (13,900–33,600) | 285 (67.8–1,040) | 564 (187–1,570) | |
| Pseudomonas pneumonia | 856 (89–4,190) | 291 (75–552) | 0.249 (0.0162–1.27) | 29,300 (5,910–114,000) | 15,500 (4,130–28,100) | 452 (49.8–1,950) | 453 (49.9– 1,950) | |
| Pseudomonas septicemia | 923 (95–3,190) | 36 (2–106) | 0.0334 (0.000716–0.186) | 38,200 (6,340–172,000) | 5,590 (722–14,000) | 214 (11.4–1,030) | 214 (11.4–1,030) | |
| Salmonellosis, nontyphoidal | 1,230 (161–4,500) | 194 (15–671) | 0.240 (0.00734–1.24) | 14,900 (4,300–46,900) | 1,520 (100–5,660) | 22.6 (0.870–110) | 22.8 (1.08–110) | |
| STEC infection, serotype O157 | 1,070 (109–2,350) | 12 (2–35) | 0.0130 (0.00734–0.051) | 19,000 (3,790–85,000) | 138 (14–503) | 2.67 (0.129–14.5) | 2.68 (0.141–14.5) | |
| STEC infection, serotype non-O157 | 1,070 (109–2,350) | 4 (0–16) | 0.00440 (0–0.0223) | 24,200 (4,780–138,000) | 74 (0–308) | 1.76 (0–11.0) | 1.76 (0.00186–11.0) | |
| Shigellosis | 952 (115–3,980) | 64 (5–311) | 0.0609 (0.00171–0.349) | 14,200 (4,130–48,000) | 245 (13–1,140) | 3.41 (0.106–18.9) | 3.47 (0.140–19.0) | |
| Vibrio spp. infection | 1,030 (293–3,330) | 76 (14–166) | 0.0777 (0.00765–0.276) | 16,000 (3,780–39,900) | 251 (153–362) | 4.02 (0.811–10.7) | 4.10 (0.891–10.8) | |
| Total cost | 322 (100–889) | 3,010 (1,120–8,410) | 3,330 (1,370–8,770) | |||||
*Values are 2004 US dollars except as indicated. Estimates rounded to 3 significant figures. CrI, credible interval; ED, emergency department; NTM, nontuberculous mycobacterial; STEC, Shiga toxin-producing E. coli. †Treat-and-release ED visits were defined as visits in which the person was not admitted to the hospital. ‡For norovirus only, costs were derived from previously published estimates that did not include uncertainty intervals. In addition, the number of ED visits includes visits in which the patient was admitted to the hospital.
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