Economic burden of meningococcal disease in children and adolescents in Tijuana, Mexico

Figures & data

Table 1. Unit costs of healthcare resources.

Resource	Unit cost (US$)	Source^a
Pre-hospitalization
Ambulatory Visit	$41.55	http://compras.imss.gob.mx/ https://www.elcontribuyente.mx/2021/01/estos-son-los-costos-de-atencion-medica-en-el-imss-en-2021/
Pediatric Emergency Room visit	$68.25	http://compras.imss.gob.mx/ https://www.elcontribuyente.mx/2021/01/estos-son-los-costos-de-atencion-medica-en-el-imss-en-2021/
Hospitalization
Hospitalization bed/day	$463.6	http://compras.imss.gob.mx/ https://www.elcontribuyente.mx/2021/01/estos-son-los-costos-de-atencion-medica-en-el-imss-en-2021/
ICU bed/day	$2207.55	http://compras.imss.gob.mx/ https://www.elcontribuyente.mx/2021/01/estos-son-los-costos-de-atencion-medica-en-el-imss-en-2021/
Surgery	$412.85	http://compras.imss.gob.mx/ https://www.elcontribuyente.mx/2021/01/estos-son-los-costos-de-atencion-medica-en-el-imss-en-2021/
Laboratory tests and diagnostic procedures
CBC	$4.06	Hospital purchasing department
C-reactive protein	$5.67	Hospital purchasing department
Erythrocyte sedimentation rate	$6.48	Hospital purchasing department
Blood culture	$65.70	Hospital purchasing department
PCR meningococcus	$50.00	Hospital purchasing department
CSF cytochemistry	$21.00	Hospital purchasing department
CSF Gram stain	$40.6	Hospital purchasing department
CSF culture	$35.18	Hospital purchasing department
Gasometry	$48.96	Hospital purchasing department
Serum electrolytes	$21.81	Hospital purchasing department
Creatinine	$3.22	Hospital purchasing department
Ureic nitrogen	$3.22	Hospital purchasing department
Glucose	$3.22	Hospital purchasing department
Albumin	$3.22	Hospital purchasing department
Liver function tests	$8.09	Hospital purchasing department
PT – Prothrombin time	$4.87	Hospital purchasing department
PTT – Partial Thromboplastin time	$4.87	Hospital purchasing department
Echocardiogram	$75.00	http://compras.imss.gob.mx/ https://www.elcontribuyente.mx/2021/01/estos-son-los-costos-de-atencion-medica-en-el-imss-en-2021/
Chest X-ray	$18.00	http://compras.imss.gob.mx/ https://www.elcontribuyente.mx/2021/01/estos-son-los-costos-de-atencion-medica-en-el-imss-en-2021/
Abdomen X-ray	$18.00	http://compras.imss.gob.mx/ https://www.elcontribuyente.mx/2021/01/estos-son-los-costos-de-atencion-medica-en-el-imss-en-2021/
Computerized Tomography - CT	$139.00	http://compras.imss.gob.mx/ https://www.elcontribuyente.mx/2021/01/estos-son-los-costos-de-atencion-medica-en-el-imss-en-2021/
Medications
Ceftriaxone, 1 g	$1.45	Hospital purchasing department
Vancomycin 500 mg	$2.15	Hospital purchasing department
Meropenem 1 g	$15.00	Hospital purchasing department
Epinephrine 1 mg	$21.75	Hospital purchasing department
Dobutamine 250 mg	$101.90	Hospital purchasing department
Post-hospitalization
Consultation/session of physical medicine and rehabilitation	$83.80	http://compras.imss.gob.mx/ https://www.elcontribuyente.mx/2021/01/estos-son-los-costos-de-atencion-medica-en-el-imss-en-2021/
Neurologic consultation	$73.15	http://compras.imss.gob.mx/ https://www.elcontribuyente.mx/2021/01/estos-son-los-costos-de-atencion-medica-en-el-imss-en-2021/
Infectious diseases consultation	$73.15	http://compras.imss.gob.mx/ https://www.elcontribuyente.mx/2021/01/estos-son-los-costos-de-atencion-medica-en-el-imss-en-2021/
Pediatric consultation	$73.15	http://compras.imss.gob.mx/ https://www.elcontribuyente.mx/2021/01/estos-son-los-costos-de-atencion-medica-en-el-imss-en-2021/

CBC, Complete Blood Count; CSF, cerebrospinal fluid; ICU, intensive care unit; g, gram, mg, milligram; PCR, polymerase chain reaction.

^aaccess to ‘http://compras.imss.gob.mx/’ is restricted outside Mexico.

All cost estimates collected in Mexican currency were converted to April 2021 US dollars (US$) ($20.00 Mexican pesos = 1.00 US$).

Table 2. Demographic characteristics and outcomes of IMD cases in children aged <16 years at Tijuana General Hospital during the study period.

	Number (%)	Additional comments
Sex
Female	23 (45%)
Male	28 (55%)
Age group
<2 years	14 (27.45%)	21 cases (41.18%) were ≤ 2 years of age 30 cases (58.82%) were 3–16 years of age
2–4 years	14 (27.45%)
5–9 years	6 (11.76%)
10–16 years	17 (33.33%)
Predisposing conditions
Yes	3 (5.88%)	Systemic lupus (n=1), HIV infection (n=1), acute lymphoblastic leukemia (n=1)
No	48 (94.11%)
Previous infection before IMD developed
Yes	20 (32.9%)	Previous upper respiratory infection reported
No	31 (60.8%)
Antibiotic treatment before hospital admission
Yes	18 (35.3%)	Amoxicillin with/without clavulanic acid
No	33 (64.7%)
Clinical presentation at admission
Meningitis with/without purpura	47 (92.15%)
Purpura only	4 (7.85%)
Conjunctivitis	4 (7.85%)
Pleural effusion	2 (3.92%)	Both had serogroup Y IMD
Serogroup distribution
C	32 (62.74%)
Y	12 (23.53%)
B	5 (9.8%)
Unknown	2 (3.92%)
Outcome
Death	13 (25.5%)
Survival with sequelae	12 (23.5%; 31.6% of survivors)	Including cortical atrophy (confirmed by the CT scan), hearing and/or motor disabilities, and skin scars
Survival without sequelae	26 (51.0%; 68.4% of survivors)

CT, computed tomography; HIV, human immunodeficiency virus; IMD, invasive meningococcal disease.

Figure 1. Number of IMD cases at Tijuana General Hospital by year* during the study period.

*Each year ran from 1 October to 30 September

IMD, invasive meningococcal disease

Table 3. Direct healthcare costs associated with IMD cases in children aged <16 years at Tijuana General Hospital during the study period.

Cost component	Average number per IMD case	Total number for all 51 IMD cases	Total cost for all 51 IMD cases (US$)
Pre-hospitalization
Ambulatory consultations	2	102	4,238.10
Emergency room consultations	1	51	3,480.75
Total			7,718.85
Hospitalization
Hospital stay			747,326.15
Days in ICU	5.43	277	611,491.35
Days in non-ICU hospital care	5.74	293	135,834.80
Laboratory tests			141,256.50
Diagnosis kit (blood and CSF culture, PCR for meningococcus, CSF cytochemistry, and Gram stain	1	51	8,972.94
Control and progress	3 per patient per day in ICU, 1 per patient per day non-ICU	1124	132,283.56
Imaging (chest and abdominal X-ray, brain CTs, and echocardiogram at admission)	1	51	12,750
Medication (antibiotics and vasopressors)			62,399.95
Post-hospitalization
Follow-up consultations		456	33,356.40
Pediatric consultation	5^a	190	13,898.50
Infectious disease consultation	5^a	190	13,898.50
Neurologic consultation	2^a	76	5,559.40
Rehabilitation		300	25,140.00
Mild sequelae	10 cases, 20 sessions each	200	16,760.00
Moderate sequelae	1 case, 40 sessions	40	3,352.00
Severe sequelae	1 case, 60 sessions	60	5,028.00
Total direct healthcare costs			1,029,947.85

CSF, cerebrospinal fluid; CT, computed tomography; ICU, intensive care unit; IMD, invasive meningococcal disease; PCR, polymerase chain reaction.

^aPer survivor.

All cost estimates collected in Mexican currency were converted to April 2021 US dollars (US$) ($20.00 Mexican pesos = 1.00 US$).

Figure 2. Average direct healthcare costs (US$) per case associated with the 51 IMD cases that occurred in children aged <16 years at Tijuana General Hospital during the study period. Total direct healthcare cost per case = US$20,195.

Hospitalization included costs for hospital stay in ICU and non-ICU.

Laboratory tests included tests for diagnosis which involved: blood culture, PCR meningococcus, CSF cytochemistry, Gram stain, and CSF culture. Tests to evaluate progress: CBC, C-reactive protein, erythrocyte sedimentation rate, gasometry, serum electrolytes, creatine, ureic nitrogen, glucose, albumin, liver function test, PT, PTT.

Medications included costs of antibiotics, epinephrine, and dobutamine. Not included: IV solutions, blood transfusions, outpatient medications, catheters, use of ventilators, others.

Post-hospitalization follow-up included follow-up consultation from the departments of neurology, pediatrics, and infectious diseases.

Rehabilitation involved the total of rehabilitation sessions for all survivors with sequelae.

Imaging included brain CT, chest X-ray, abdominal X-ray, and echocardiogram.

Pre-hospitalization included ambulatory visits before hospitalization and pediatric emergency consultations

CBC, Complete Blood Count; CSF, cerebrospinal fluid; CT, computed tomography; ICU, intensive care unit; IV, intravenous; IMD, invasive meningococcal disease; PCR, polymerase chain reaction; PT, prothrombin time; PTT, partial thromboplastin time

Figure 3. Overall economic burden (US$) by age group, including direct healthcare costs and indirect societal costs, associated with the 51 IMD cases that occurred in children aged <16 years at Tijuana General Hospital during the study period.

IMD, invasive meningococcal disease

Figure 4. Annual total economic burden (US$) including direct healthcare costs and indirect societal costs associated with IMD in children aged <16 years in Tijuana, Mexico.

IMD, invasive meningococcal disease