Lyme disease is associated with significant health care costs

1. Lyme disease (LD) is associated with substantial health care costs, with per-patient direct costs consistently high across several analytic methods.

2. Disseminated LD drives the majority of costs, with increased medical and out-of-pocket expenses compared to localized disease, and accounts for hundreds of millions of dollars annually. 

Evidence Rating Level: 2 (Good)

Study Rundown: Lyme disease (LD) is the most common vector-borne illness in the United States, primarily in 15 US states, although it is expanding its geographic range. Most cases present as localized disease with a single erythema migrans rash and flu-like symptoms, while disseminated disease can involve multiple rashes, joints, neurologic or cardiac manifestations. Previous studies have examined Lyme disease-related health care costs; however, many use older data, limited populations, or do not distinguish between localized and disseminated disease. This study aims to use more recent and comprehensive data to estimate total and out-of-pocket healthcare costs for Lyme disease across the US, comparing localized versus disseminated disease and stratifying results by state incidence. To do so, this retrospective cohort study uses Optum’s deidentified Market Clarity database to identify patients diagnosed with LD between 2014 and 2023 who had at least 14 months of continuous health plan enrollment. Patients with disseminated LD accrued substantially higher health care costs than patients with localized LD. Overall, LD places a significant burden on the US healthcare system while also presenting monetary challenges for patients, especially those with disseminated LD. The study was limited by the shorter follow-up period of 6 months, as it was not able to determine further costs for patients with persistent symptoms. Despite this, the study emphasizes the need for effective LD prevention for both the individuals and the healthcare system.

Click here to read the study in JAMA Network Open 

Relevant Reading: Economic Burden of Reported Lyme Disease in High-Incidence Areas, United States, 2014–2016 

In-Depth [retrospective cohort study]: A total of 70,531 patients with LD were included (mean age [SD] 44.8 [21.3] years, 48.7% male). On average, the medical cost of treating a case of LD was $2227 (95% CI, $2111-$2342). Costs were much higher for patients with disseminated disease, averaging $6833 (95% CI, $6397-$7269) compared with $695 (95% CI, $628-762) for patients with localized disease. Costs increased by $3304, with much larger increases for disseminated disease ($10,130 [95% CI, $9531-$10,728]) than for localized disease ($1381 [95% CI, $1207-$1554]). There were similar cost increases in high-incidence states, where overall cost rose by $3217, again mainly driven by disseminated disease ($10,020 [95% CI, $9355-$10,686] rather than localized disease ($1340 [95% CI, $1161-$1519). Out-of-pocket (OOP) costs also increased significantly after diagnosis. Among 9908 patients, average OOP spending was $240 greater in the 6 months after LD diagnosis compared with before diagnosis. Similar to previous, the increase was greater for patients with disseminated disease ($623 [95% CI, $561-$725]) than those with localized disease ($123 [95% CI, $91-$154]). Using LD episode and case-control estimates, the study projected that total LD-related healthcare costs range from $591 million to $1.05 billion ( 2022 dollars), with $411 million to $771 million of these costs attributable to disseminated LD. Overall, LD results in significant cost for the healthcare system in the US, and for those experiencing disseminated disease in particular. 

Image: PD

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