July 14, 2010
Contact: CDC Division of Media Relations
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Waterborne Diseases Could Cost over $500 Million Annually in U.S.

Hospitalizations for three common waterborne diseases cost the health care system as much as $539 million annually, according to research presented today at the International Conference on Emerging Infectious Diseases.

"These cost data highlight that water-related diseases pose not only a physical burden to the thousands of people sickened by them each year, but also a substantial burden in health care costs, including direct government payments through Medicare and Medicaid," says Michael Beach of the Centers for Disease Control and Prevention, an author of the study.

Currently, there are no well-documented data on the total health care costs associated with all waterborne diseases. However, using data from a large insurance claims database between 2004 and 2007, Beach and his colleagues estimated the hospitalization cost of three common waterborne diseases in the United States: Legionnaires' disease, cryptosporidiosis and giardiasis. For each case of disease, they calculated the cost paid by the insurer, the out-of-pocket cost to the patient, and the total amount paid.

Total estimated costs for hospitalization for the three diseases was $154-539 million, including $44-147 million in direct government payments for Medicare and Medicaid. Estimated annual costs for the individual diseases were: giardiasis, $16-63 million; cryptosporidiosis, $37-145 million; and Legionnaires' disease, $101-321 million.

Inpatient hospitalization costs per case averaged more than $34,000 for Legionnaires' disease, approximately $9,000 for giardiasis and more than $21,000 for cryptosporidiosis.

"When people think about these diseases, they usually think of a simple case of diarrhea, which is a nuisance but quickly goes away. However, these infections can cause severe illness that often result in hospital stays of more than a week, which can quickly drive up health care costs," Beach says.

Other symptoms can include rashes, eye and ear infections and respiratory or neurological symptoms and can even be fatal.

Modest investments in preventing these diseases could lead to reduced disease and significant healthcare cost savings, Beach says. Some examples of possible, low-cost interventions include public education campaigns, appropriate maintenance of building water systems, and regular inspection of pools and other recreational water facilities.

The International Conference on Emerging Infectious Diseases is organized by the CDC, the American Society for Microbiology, the Council of State and Territorial Epidemiologists, the Association of Public Health Laboratories and the World Health Organization. More information on the meeting can be found online at http://www.iceid.org/.

“Editor′s Note: The preliminary cost data on water-related disease referenced in this press release have been finalized. The final data are summarized in the following publication. Direct healthcare costs of selected diseases primarily or partially transmitted by water. Epidemiology and Infection. 2012; Jan 11.” (The new data are available at http://www.ncbi.nlm.nih.gov/pubmed/22233584) and these data supersede the preliminary data released by CDC on July 14, 2010.

Epidemiol Infect. 2012 Nov; 140(11):2003-13. Epub 2012 Jan 11.

Direct healthcare costs of selected diseases primarily or partially transmitted by water.

Collier SA1, Stockman LJ, Hicks LA, Garrison LE, Zhou FJ, Beach MJ.
Author information

Despite US sanitation advancements, millions of waterborne disease cases occur annually, although the precise burden of disease is not well quantified. Estimating the direct healthcare cost of specific infections would be useful in prioritizing waterborne disease prevention activities. Hospitalization and outpatient visit costs per case and total US hospitalization costs for ten waterborne diseases were calculated using large healthcare claims and hospital discharge databases. The five primarily waterborne diseases in this analysis (giardiasis, cryptosporidiosis, Legionnaires' disease, otitis externa, and non-tuberculous mycobacterial infection) were responsible for over 40,000 hospitalizations at a cost of $970 million per year, including at least $430 million in hospitalization costs for Medicaid and Medicare patients. An additional 50,000 hospitalizations for campylobacteriosis, salmonellosis, shigellosis, haemolytic uraemic syndrome, and toxoplasmosis cost $860 million annually ($390 million in payments for Medicaid and Medicare patients), a portion of which can be assumed to be due to waterborne transmission.

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