PURPOSE: Bacterial conjunctivitis accounts for 50% of all conjunctivitis cases in the United States (US). Hallmark symptoms include eye redness and mucopurulent discharge. Despite a range of topical antibiotic treatments available, bacterial conjunctivitis still poses significant economic and humanistic burden ranging from lost work productivity, significant healthcare resource utilization (HCRU) and increased healthcare expenditure estimated to be around $800 million annually. This study aims to quantify the economic and HCRU burden of bacterial conjunctivitis.

METHODS: The case-only cross-sectional study identified patient with a diagnosis of conjunctivitis and an associated prescription for an ophthalmic anti-bacterial agent between January 2018 – December 2023 in the Medical Expenditure Panel Survey (MEPS) database. Total healthcare costs comprise of direct and indirect costs. Direct costs were calculated as a sum of patient out-of-pocket costs and insurer-paid costs. Indirect costs were estimated based on wage-based productivity loss due to work absenteeism. All costs were inflation-adjusted to 2026 using the Consumer Price Index. HCRU was measured using pharmacy visits, office-based visits, outpatient visits and emergency room (ER) visits. Cost and prevalence trends were estimated to identify variation across the 6-year period.

RESULTS: Study identified ~6.1 million patient cases receiving an anti-bacterial agent for bacterial conjunctivitis over the 6-year period with an average annual case rate of over 1 million. Majority of the patients were children (53.8%), female (59.2%) and non-Hispanic White (72.9%) belonging to high income (>400% poverty line) households (53.1%) with private insurance (73.2%) and a mean (SD) cohort age of 23.7 (23.2) years. Mean (SD) number of pharmacy events and costs were 1.2 (0.45) and $34.6 ($66.4) respectively. Mean (SD) office-based visits and costs were 0.9 (0.83) and $260.0 ($489.0) respectively. Mean (SD) outpatient visits and costs were 0.1 (0.29) and $377.8 ($636.4) respectively. Mean (SD) ER visits and costs were 0.1 (0.24) and $412.4 ($228.6) respectively. Total mean direct healthcare expenditure was $278.1. Total mean indirect healthcare expenditure was $445.8 assuming two workdays of absenteeism either as a patient or as a caregiver. Total mean healthcare expenditure was $723.9 over the 6-year period. Prevalence of bacterial conjunctivitis ranged from 0.2 to 1.8 million whereas total mean healthcare expenditure ranged from $154.9 to $1,290.2 over the 6-year period.

CONCLUSION: Bacterial conjunctivitis despite being an acute condition poses significant HCRU and healthcare expenditure burden in the US primarily affecting children and females. Higher indirect compared to direct healthcare costs are an indication of significant productivity lost due to absenteeism as well as the acute nature of the condition. Lower prevalence and healthcare expenditure trend estimates are typically observed in the COVID-19 years.