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Acute Infectious Gastroenteritis (AGE): A Common Reason Behind Outpatient Visits and Hospitalizations in the U.S.

Key takeaways:

  • Study confirms that acute infectious gastroenteritis (AGE) is a common and costly medical condition that affects adults of all ages across races and ethnicities.
  • Large multiplex polymerase chain reaction (PCR) panels had a substantially more rapid turnaround time and increased diagnostic yield as well as a lower incidence of antibiotic use, compared to traditional work-up.
  • There are possible benefits to multiplex PCR panels such as fewer antibiotics, reduced visits and lower costs of follow up care.

Acute infectious gastroenteritis (AGE) is a frequent reason for outpatient visits and hospitalizations in the U.S. However, the burden of AGE in the adult outpatient population has not been comprehensively analyzed.

There is a need to determine the impact of diagnostic test methods on healthcare costs and outcomes in adults with AGE. In addition, researchers want to understand the common pathogens detected and healthcare resource use (HRU) among AGE adult outpatients visiting U.S. health systems to better inform treatment decisions and healthcare resource allocation.

Research collaboration between bioMérieux and PINC AI™ Applied Sciences (PAS) strives to understand the epidemiology, HRU and costs related to AGE in adult patients.

bioMérieux, a global leader in in vitro diagnostics, joined forces with the PAS team utilizing the PINC AI™ Healthcare Database (PHD) to obtain real-world evidence on the consequences of AGE in adult outpatients in the U.S.

The PINC AI-bioMérieux Research Study

The Research team selected the PHD, based on the breadth and depth of patient data, as the data source for this retrospective cohort study among adult (aged ≥ 18 years) outpatients in the U.S. Data chosen included those patients with a principal diagnosis of AGE during a visit that occurred between April 1, 2016, and June 30, 2021, with pathogen detection and stool test analysis performed in those with microbiology data available.

The goal of this study was twofold:

  • To understand the epidemiology, HRU and cost of AGE-related outpatient visits.
  • To determine the relationship between diagnostic testing method and HRU, cost, number and turnaround time of stool tests and commonly detected pathogens in U.S. adult outpatients with AGE.

Researchers found:

  • Among 248,896 outpatients visiting a hospital for AGE, approximately 85 percent were seen in the emergency room, and 96 percent were discharged home.
  • Female predominance (1.7:1 ratio) was seen in all age groups and geographic regions among AGE outpatients visiting hospitals.
  • Only 18 percent of patients underwent diagnostic stool testing at the hospital and the mean cost of stool testing per patient was less than 15 percent of the mean total healthcare cost per patient.
  • Within 30 days of discharge, one percent of patients were hospitalized and almost three percent had another outpatient visit due to AGE.
  • Mean cost of the index visit plus 30-day AGE-related follow-up was $1,338 per patient, or $333,060,182 for the total study population.
  • Among patients with microbiology data available, common pathogens detected included Clostridioides difficile, norovirus and Campylobacter spp.
  • Although a traditional diagnostic work-up was most frequently performed, results were delayed (mean stool test turnaround time: 32 hours), and testing failed to identify a pathogen in more than half of patients.
  • Multiplex polymerase chain reaction (PCR) panels were able to detect multiple bacteria and viruses with a single stool test, provided more rapid results (mean stool test turnaround time: six hours), and identified more pathogens, in particular diarrheagenic E. coli and enteric viruses.
  • Fewer patients tested with large multiplex PCR panels received follow up care in the form of antibiotics, required additional visits or diagnostic tests, or were hospitalized for gastroenteritis within 30 days.
  • The slightly higher cost of large multiplex PCR panels was offset by lower costs of follow-up care.

The results of this study, presented at ID Week 2022 and published in the American Journal of Gastroenterology and Journal of Clinical Microbiology, support the benefits of using large multiplex PCR panels when stool testing is indicated among AGE outpatients visiting U.S. health systems.

Robust Data at Researchers’ Fingertips

This study illustrates the power of utilizing real-world data to analyze the healthcare impacts of diagnostic testing and obtain insights that can help clinicians and laboratories select testing approaches that can improve clinical outcomes.

The PAS team partners with life sciences, academia, government agencies, and healthcare insurers and health systems, enabling them with robust PHD data for real-world applied research and analytics, science implementation and prospective research and clinical trials. The data informs evidence-based practices and may be utilized to improve quality, safety and cost-effectiveness of care.

The PHD comprises more than 20 years of de-identified data from over 1,263 sites spanning multiple therapeutic areas and quality improvement areas. Currently, the PHD contains data from more than 1 billion inpatient and outpatient encounters.

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