Causes and costs of hospitalization of tuberculosis patients in the UnitedStates

OBJECTIVE: To examine the costs, lengths of stay and patient characteristic s associated with tuberculosis (TB) hospitalizations, METHODS: A Prospective cohort study of 1493 TB patients followed from diagn osis to completion of therapy at 10 public health programs and area hospita ls in the US. The main outcome measures were the following: 1) occurrence, 2) cost, and 3) length of stay of TB-related hospitalizations. RESULTS: There were 821 TB-related hospitalizations among the study partici pants; 678 (83%) were initial hospitalizations and 143 (17%) were hospitali zations during the treatment of TB. Patients infected with human immunodefi ciency virus (HIV) (OR 1.8, 95% CI 1.2-2.6), and homeless patients (OR, 1.7 95% CI 1.1-2.8) were at increased risk of being hospitalized at diagnosis. Homeless patients (RR 2.5, 95% CI 1.5-4.3), patients who used alcohol exce ssively (RR 1.9, 95% CI 1.2-3.0), and patients with multidrug-resistant TB (RR 5.7, 95% CI 2.7-11.8) were at increased risk of hospitalization during treatment. The median length of stay varied from 9 to 17 days, and median c osts per hospitalization varied from $6441 to $12 968 among the sites. CONCLUSION: Important social factors, HIV infection, and local hospitalizat ion practice patterns contribute significantly to the high cost of TB-relat ed hospitalizations. Efforts to address these specific factors are needed t o reduce the cost of preventable hospitalizations.