Hospitalization markedly increases the costs of bronchiectasis care and management, especially in patients who experience flare-ups, a review of published studies shows.
The study with that finding, “The economic burden of bronchiectasis – known and unknown: a systematic review” was published in the journal BMC Pulmonary Medicine.
The prevalence of bronchiectasis is rising, which warrants a better understanding of the cost burden of the disease to help improve the planning and distribution of funds for care management, and ultimately achieve better clinical and economic outcomes.
Researchers reviewed published data concerning the costs associated with bronchiectasis management incurred by patients and the healthcare system. A total of 26 studies were identified that described the use of resources and the costs in managing bronchiectasis. These studies were published in medical databases from January 2001 to December 2016.
Of the 26 studies, 15 included more than 200 patients. Among the 15, six studies were conducted in the U.S., three in the U.K., two in Spain, and one each in Germany, Singapore, New Zealand, and Poland.
The use of resources was described in 24 studies. It included inpatient and outpatient care, and the use of medications and other treatments. Inpatient care was reported in terms of hospital admission, emergency department (ER) visits, and intensive care unit (ICU) stays. Outpatient care included primary and secondary visits, diagnostic test visits, condition monitoring, physiotherapy, and airway clearance sessions.
Two of the U.S. studies reviewed insurance claims to compare the resource use and costs supported by bronchiectasis patients to a control group without the condition. They found that the number of hospital admissions was higher in the patient group (0.6) compared to controls (0.4). Similarly, bronchiectasis patients stayed in the hospital longer (4.5 days) than the control group (2.5 days). Also, the duration of medication and treatment use was higher in bronchiectasis patients than in the control group.
This increase in resource use imposed a higher additional annual cost on bronchiectasis patients ($5,681 per patient) compared to the controls ($2,319). Inpatient care contributed to the majority (56%) of the increase, while prescription medications (18%) and outpatient visits (16%) accounted for most of the remainder of the increased costs.
In 12 studies, the average length of stay in the hospital was two to 17 days. The mean annual rate of hospitalization per patient was reported in six studies, and was in the range of 0.3 to 1.3 admissions. In four studies, patient age was considered for calculating the age-adjusted mean hospitalization rate per year, which was reported to be in range of 1.8 to 25.7 admissions per 100,000 population.
Eight studies informed about the cost of managing bronchiectasis and influencing factors. Among these, two Spanish studies reported a total annual management cost per patient of 3,515 Euros (about $4,000) and 4,672 Euros (about $5,300). One of the Spanish studies noted that flare-ups added to this annual cost, and it was higher in patients with more than two episodes per year (7,520 Euros; $8,557), compared to those with no exacerbations (3,892 Euros; about $4,429).
A similar trend was noted in two U.S. studies that reported an increase to $36,000–$37,000 in patients with exacerbations, compared to about $26,000 total costs in the absence of such episodes.
Overall, hospitalizations were seen as the significant factor that influenced the increase in management costs, the team found. Hospital admissions were primarily needed due to Pseudomonas aeruginosa infections. Two U.S. studies reported that P. aeruginosa infection-related cost increase was in the range of $31,551 to $56,499.
“The published literature suggests that hospitalization costs constitute a major economic burden associated with bronchiectasis, especially in patients who experience frequent exacerbations,” the researchers wrote.
According to the team, these studies have limitations because most of them are retrospective (re-analyzing existing data), do not explore the outpatient care costs, and have identified patients filing insurance claims. Such studies may not provide an accurate picture of the financial burden imposed by bronchiectasis, they noted.
The team recommended “a conceptual framework” that considers multiple factors for future prospective and retrospective studies. These factors include lung function, ER and ICU visits, intravenous treatment, non-invasive ventilation therapy, condition monitoring, and health-related quality of life, among others.
“Considering patients across the whole disease spectrum, the impact of comorbidities, and the impact of bronchiectasis on other conditions will also be important to comprehensively map the economic burden of bronchiectasis,” the team added.