Calculating the economic burden of presumed microbial keratitis admissions at a tertiary referral centre in the UK

George Moussa,James Hodson,Cristina Penaloza,Saaeha Rauz,Nick Gooch,Jasvir Virdee,Jesse Kigozi

doi:10.1038/s41433-020-01333-9

Abstract

PurposeMicrobial keratitis (MK) is the most common non-surgical ophthalmic emergency admission in the UK. However, few prospective health-economic studies of MK have been performed, and no specific healthcare resources group (HRG) code exists. This study is designed to determine the feasibility of a data collection tool derived from the microbiology ophthalmology group (MOG) clinical record form, to enable quantification of direct costs of inpatient care, as well as prospective capture of epidemiological data relating to outcomes of MK.MethodsClinical, demographic and economic data were collected retrospectively between January and December 2013 for 101 consecutive patients admitted with MK, using an adaption of the MOG toolset. The direct cost of admission (COA) was calculated using national reference costs and compared to actual income to generate profit/deficit profiles for individual patients. Indices of multiple deprivation were used to assess effect of deprivation on the COA.ResultsThe total income generated through discharge coding was £252,116, compared to a COA of £357,075, yielding a deficit of £104,960 (median: £754 per patient). The cost deficit increased significantly with length of stay (LOS, p < 0.001), whilst patients with short LOS were income generators; cost neutrality occurred at 4.8 days. Greater socioeconomic deprivation was also associated with a significantly higher cost deficit.ConclusionLOS is the key driver for COA of care for MK admissions. Protocols should encourage discharge of patients who are able to self-administer treatment after the sterilisation phase. The MOG-derived data collection toolset captures pertinent clinical data for quantification of COA. Further development into a multiuser and multisite platform is required for robust prospective testing, together with expansion to capture indirect costs of disease burden, including impact of treatment, visual morbidity and quality of life.

Highlights

IntroductionMicrobial keratitis (MK) is a leading cause of global blindness
Supplementary information The online version of this article contains supplementary material, which is available to authorized users.Microbial keratitis (MK) is a leading cause of global blindness
As corneal scrapes to microbiologically confirm a causative microbe are reported to have a sensitivity of only 23.7–61.5% [3], most reports of MK refer to a clinical diagnosis of presumed MK

Summary

Introduction

Microbial keratitis (MK) is a leading cause of global blindness. Prevalence and underlying causative organisms vary across geographical regions [1], ranging from 11 per 100,000 in the USA to 799 per 100,000 per year in Nepal [2]. MK forms the most common non-surgical ophthalmic emergency in the UK, with an estimated incidence of 40–52 people per 100,000 per year [1]. Patients present to the emergency department with painful, reduced vision. Corneal scrapes for microscopy, culture and sensitivity and polymerase chain reaction (PCR) for pathogen DNA provide mainstay investigations. As corneal scrapes to microbiologically confirm a causative microbe are reported to have a sensitivity of only 23.7–61.5% [3], most reports of MK refer to a clinical diagnosis of presumed MK

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