Healthcare Resource Utilization and Costs Associated With Infectious Mononucleosis in the United States

OBJECTIVES: Epstein-Barr virus (EBV) is a common herpes virus that infects most people during their lifetime. EBV causes over 90% of infectious mononucleosis (IM) cases which can result in prolonged symptoms, such as fever and swollen lymph nodes, as well as hospitalization. We examined healthcare resource utilization (HCRU) and costs attributable to IM in US claims data.

METHODS: Utilizing the Merative™ MarketScan® Commercial Claims and Encounters and Medicaid databases during the pre-COVID-19 pandemic period (June 2017-February 2020), individuals aged 5-40 years with IM diagnosis (ICD-10: B27.0x, B27.8x, B27.9x) were selected for the IM cohort (first diagnosis=index date). Controls (no IM diagnosis at any point) were matched 1:1 on a healthcare visit date (same as the index date for the case ±7 days) as well as demographics and comorbidities at baseline. Individuals with any transplant diagnosis were excluded. Individuals were required to have ≥6 months of continuous enrollment pre-index (baseline) and post-index (follow-up). All-cause HCRU and total direct costs (in 2022 USD) were summarized over a 6-month follow-up period.

RESULTS: 22,906 Commercially-insured and 8,197 Medicaid-enrolled matched pairs were included. Among Commercial pairs, the mean (SD) age at index date was 18(±6) years and 57% were female. Among Medicaid pairs, the mean age was 14(±6) years and 61% were female. During the 6-month follow-up, IM cases had a higher median number of total HCRU visits compared with controls (Commercial: 5.0 [IQR: 3.0-8.0]) vs. 3.0 [2.0-7.0]; Medicaid: 6.0 [4.0-11.0] vs. 5.0 [2.0-10.0], all p<0.001). Median total costs (medical+pharmacy) were $1,333 [IQR: $541-$3,424] for Commercial cases (vs. $841 [$346-$2,281] for controls) and $897 [$381-$1,995] for Medicaid cases (vs. $577 [$237-$1,428] for controls, all p<0.001).

CONCLUSIONS: Individuals diagnosed with IM in the US had higher HCRU and costs during the 6-month follow-up than non-IM controls. IM prevention via EBV vaccination may have a positive impact on healthcare resource use.