Department of Respiratory Diseases, AZ Nikolaas, Sint-Niklaas, Belgium and Department of Respiratory Diseases, UZ Leuven, Leuven, Belgium.
Pharmerit, Rotterdam, The Netherlands.
BMC Pulm Med. 2019 Feb 28;19(1):54. doi: 10.1186/s12890-019-0818-6.
The increasing prevalence and recognition of bronchiectasis in clinical practice necessitates a better understanding of the economic disease burden to improve the management and achieve better clinical and economic outcomes. This study aimed to assess the economic burden of bronchiectasis based on a review of published literature.
A systematic literature review was conducted using MEDLINE, Embase, EconLit and Cochrane databases to identify publications (1 January 2001 to 31 December 2016) on the economic burden of bronchiectasis in adults.
A total of 26 publications were identified that reported resource use and costs associated with management of bronchiectasis. Two US studies reported annual incremental costs of bronchiectasis versus matched controls of US$5681 and US$2319 per patient. Twenty-four studies reported on hospitalization rates or duration of hospitalization for patients with bronchiectasis. Mean annual hospitalization rates per patient, reported in six studies, ranged from 0.3-1.3, while mean annual age-adjusted hospitalization rates, reported in four studies, ranged from 1.8-25.7 per 100,000 population. The average duration of hospitalization, reported in 12 studies, ranged from 2 to 17 days. Eight publications reported management costs of bronchiectasis. Total annual management costs of €3515 and €4672 per patient were reported in two Spanish studies. Two US studies reported total costs of approximately US$26,000 in patients without exacerbations, increasing to US$36,00-37,000 in patients with exacerbations. Similarly, a Spanish study reported higher total annual costs for patients with > 2 exacerbations per year (€7520) compared with those without exacerbations (€3892). P. aeruginosa infection increased management costs by US$31,551 to US$56,499, as reported in two US studies, with hospitalization being the main cost driver.
The current literature suggests that the economic burden of bronchiectasis in society is significant. Hospitalization costs are the major driver behind these costs, especially in patients with frequent exacerbations. However, the true economic burden of bronchiectasis is likely to be underestimated because most studies were retrospective, used ICD-9-CM coding to identify patients, and often ignored outpatient burden and cost. We present a conceptual framework to facilitate a more comprehensive assessment of the true burden of bronchiectasis for individuals, healthcare systems and society.
支气管扩张症在临床实践中的发病率和认知度不断提高，这就需要更好地了解其经济疾病负担，以改善管理，实现更好的临床和经济效果。本研究旨在通过对已发表文献的回顾，评估支气管扩张症的经济负担。
采用 MEDLINE、Embase、EconLit 和 Cochrane 数据库对 2001 年 1 月至 2016 年 12 月期间发表的成人支气管扩张症经济负担的相关文献进行系统回顾。
共确定了 26 篇报告与支气管扩张症管理相关的资源使用和成本的文献。两项美国研究报告，支气管扩张症患者相对于匹配对照组每年的增量成本分别为 5681 美元和 2319 美元。24 项研究报告了支气管扩张症患者的住院率或住院时间。6 项研究报告的每位患者年平均住院率范围为 0.3-1.3，4 项研究报告的年平均年龄调整后住院率范围为 1.8-25.7/10 万人口。12 项研究报告的平均住院时间范围为 2-17 天。8 项研究报告了支气管扩张症的管理成本。两项西班牙研究报告的每位患者年管理总成本分别为 3515 欧元和 4672 欧元。两项美国研究报告，在没有加重的情况下，每位患者的总成本约为 26000 美元，在有加重的情况下，增加到 36000-37000 美元。同样，西班牙的一项研究报告，每年有>2 次加重的患者的总年度成本（7520 欧元）高于无加重的患者（3892 欧元）。两项美国研究报告，铜绿假单胞菌感染使管理成本增加 31551 美元至 56499 美元，这主要是由于住院造成的。
目前的文献表明，支气管扩张症在社会中的经济负担是巨大的。住院费用是这些费用的主要驱动因素，尤其是在频繁加重的患者中。然而，由于大多数研究是回顾性的，使用 ICD-9-CM 编码来识别患者，并且经常忽略门诊负担和成本，因此，支气管扩张症的真实经济负担可能被低估了。我们提出了一个概念框架，以促进对个人、医疗保健系统和社会中支气管扩张症真实负担的更全面评估。
