P74. Cost impact of intravenous drug use on the treatment of spine infections

Abstract

<h3>BACKGROUND CONTEXT</h3> Intravenous drug use (IVDU) is the most common cause of spinal infections in otherwise healthy young patients without medical risk factors or significant comorbidities. IVDU is also associated with significant medical and psychological morbidity and mortality, resulting in a large financial burden to the entire health care system. Psychosocial issues and noncompliance are common, plaguing and complicating the logistics of standard of care. <h3>PURPOSE</h3> The purpose of this study is to identify the cost of treating spinal infections in patients with IVDU history and compare it to the cost of treating similar infections in medical patients without IVDU history. <h3>METHODS</h3> A retrospective chart review was performed to identify all adult patients admitted in 2018 to a single tertiary referral center with a diagnosis of discitis, vertebral osteomyelitis, or spinal epidural abscess. Information on demographics, treatment, comorbidities, costs of treatment, and payment were collected for each patient. Data was compared between the group with IVDU history and the group without. <h3>RESULTS</h3> A total of 130 patients met inclusion criteria; 42 had IVDU history and 88 did not. The non-IVDU group was found to be older (age of 63.7 years vs 41.3 years, p<0.0001) with higher rates of diabetes, end stage renal disease, and cancer, and lower rates of infective endocarditis and liver disease. The average length of stay in the hospital was 28.1 days for the IVDU group, and 13.5 for the non-IVDU group (p<0.0001). Nine (21.4%) of the IVDU group were able to be discharged to rehab or long-term care facility for treatment, while 38 (43.2%) of the non-IVDU were discharged to another facility (p=0.0001). Forty (95.2%) of the IVDU group and 75 (85.2%) of the non-IVDU group had either Medicare or Medicaid as their insurance (p=0.06). Average total charge per hospitalization for the patients in the IVDU group was $141,070 and $125,283 in the non-IVDU group (p=0.41). Insurance payment per day was significantly lower in the IVDU group compared to the non-IVDU group, with the values being $1,231.47 and $3,549.61, respectively (p=0.0008). Total cost per day to the hospital was also significantly lower in the IVDU group, who had a per day cost of $3,374.16 compared to $6,788.19 in the non-IVDU group (p=0.0049). Total charges per day were lower in the IVDU group at $6,192 compared to $10,151.20 in the non-IVDU group (p=0.0009). <h3>CONCLUSIONS</h3> While those who use IV drugs do not cost the hospital as much per day as others being treated for spinal infections, the length of stay for these patients is more than double that of non-IV drug users. This is likely due to the practice in many hospitals, where active IVDU history is a contraindication to discharge with long-term intravenous access (such as peripheral intravenous central catheters). This population is also often self-pay or Medicaid, thereby often not accepted by short-term rehabilitation or long-term care facilities to finish their medical treatment. Tertiary care centers are often left to treat these patients until completion of intravenous course. This constellation of situational consequences results in a significant loss of revenue and tieing-up of resources that could otherwise be utilized on other patients. This study quantifies the significant cost burden created by IVDU-associated spine infections in one tertiary academic hospital center and offers insight on specific areas where policy and public health can help in minimizing the cost of this epidemic. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.