Campylobacter infection and related illness is associated with a substantial economic burden in Germany, according to a study.

Researchers analyzed the use of health care and direct and indirect costs of Campylobacter and care-intensive long-lasting health issues of patients from health insurance data with 26 million members in Germany.

Claims data of insurants with at least one Campylobacter diagnosis in 2017 were provided, of which 9,945 were included in the analysis published in the journal Plos One.

This showed a lower rate of Campylobacter diagnoses than German surveillance data for 2017 but with similar age, gender, and regional distribution. According to both the surveillance and claims data, rates were lowest in the 5 to 14 age group and highest for females aged 20 to 24. 

Some people developed post-infectious reactive arthritis, Guillain-Barré syndrome (GBS), inflammatory bowel disease (IBD), and/or irritable bowel syndrome (IBS).

Total cost estimates
Average Campylobacter-specific costs per patient receiving outpatient care were €524 ($573) over a 12-month period, while costs per hospitalized case amounted to €2,830 ($3,100). Analyzed partial costs ranged between €221 ($241) for IBS and €22,721 ($24,800) for GBS per patient per 12 months. Total costs of Campylobacter infection and sequelae in Germany in 2017 ranged between €74.25 million and €95.19 million ($81.2 million and $104 million).

Data were also provided for a control group. For each insurant with at least one Campylobacter diagnosis in 2017, three randomly selected insurants matching in terms of age, gender, and place of residence were included.

About half of the study population was female and the median age was 47. The study period for each patient and control they were ranged between 21 and 36 months.

Based on Campylobacter-specific health care utilization, 63.7 percent of patients were categorized as moderate and 36.3 percent as severe cases. More than one Campylobacter diagnosis during the analyzed period was made for some patients.

Direct health care costs correspond to payments made by the insurance and co-payments by patients according to claims data. Indirect costs were calculated by multiplying work incapacities by average labor costs. Costs of medical care in hospitals, of rehabilitation, and of work incapacities linked to diagnoses of Campylobacter or sequelae were assessed separately for each patient. 

Impact of illness severity on Costs
Almost 4,500 patients had a Campylobacter-associated hospital stay. Hospitalization with principal Campylobacter diagnoses lasted on average five days, while female and older patients had a longer duration. 

For moderate patients aged 15 to 64, work incapacities lasted an average of eight days, which was longer than the three days for hospitalized patients. However, the proportion of patients with work issues was higher in people with severe Campylobacter than those moderately affected.

The highest proportion of hospitalizations was among GBS patients, with an average stay of 21 days every one and a half years. Work incapacities were most common and longest for GBS patients, while those with other sequelae had short absences from work of up to five days per 12 months.

Costs differed between age groups: Patients older than 65 developed the highest direct costs, whereas indirect expenses were primarily incurred by patients aged 15 to 64. Women showed slightly higher costs of outpatient medical care and prescribed medication, while men with severe illnesses tended to have higher indirect costs. 

The total cost of illness was lowest for patients between five and 14 years old and highest for the age group 30 to 64 for both moderate and severe Campylobacter.

Hospitalizations were the largest cost factor for severely affected patients. For patients with moderate Campylobacter, productivity losses accounted for the largest share.

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