Assessment of Direct Costs of Admission Due to Presumed Microbial Keratitis in a Tertiary Referral Hospital in Thailand: A 7-Year Retrospective Study

Abstract

Objective

To evaluate the direct healthcare cost of admission and examine the effects of cost drivers of treating presumed microbial keratitis (MK) at a tertiary referral hospital.

Design

Retrospective study.

Methods

A total of 741 patients who presented with MK were included. All information regarding costs was collected, and demographic data were employed for risk factor analysis.

Results

The total cost of treating MK over a 7-year period at Rajavithi Hospital was US$14,514,625.04, while the median cost was US$10,840.17 per patient (Q1–3, US$5866.56–24,172.28). The medical professional services were the highest cost category in terms of both total cost of treatment over 7 years and median cost per patient, accounting for US$6,474,718.43 and US$5235.20 (Q1–3, US$2582.79–10,474.24) respectively. In 2020, the total cost of treatment declined, corresponding with fewer hospitalized patients; however, the median cost per patient was the highest of all years, amounting to US$15,089.90 (Q1–3, US$8064.17–29102.50), while the median cost per patient from 2014 to 2019 was US$9969.96 (Q1–3, US$5177.98–21,942.68). Statistical significance was found in the median cost per patient in 2020 compared to the median cost per patient in 2014–2019 (p-value 0.019). Risk factors associated with the more expensive cost of treatment were longer length of stay (LOS); age more than 60 years old; readmission; diabetes mellitus (DM); hypertension; and heart disease.

Conclusion

There were several key factors impacting the direct healthcare costs of severe MK treatment. Medical professional services emerged as the most substantial cost category, while longer hospital stays, older age groups, readmission cases, and comorbidities such as diabetes mellitus, hypertension, and heart disease were all linked to elevated treatment expenses. There were no statistically significant differences in the direct medical expenses during hospitalization associated with treating severe MK, whether the culture results were positive or negative, or regardless of the type of cultured organism utilized.

Keywords:

• corneal ulcer
• infectious keratitis
• healthcare cost
• economic burden

Acknowledgment

We wish to express our gratitude to Mr. John Flanagan for his proofreading of this research project, which contributed to its clarity and accuracy. The support received from the Rajavithi research grant (Grant number 64100/2564) has been instrumental in advancing our study. We also extend our thanks to Assoc. Prof. Dusit Sujirarat, Krissana Arsayot, and Panida Yoopetcch for their assistance in conducting statistical analysis and providing constructive feedback, which significantly enhanced the quality and rigor of this research manuscript.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.