Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.
School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
BMC Pediatr. 2020 Mar 25;20(1):136. doi: 10.1186/s12887-020-02037-5.
Bronchopulmonary dysplasia (BPD) is among the most severe chronic lung diseases and predominantly affects premature infants. There is a general understanding of BPD's significant impact on the short-term outcomes however there is little evidence on long-term outcomes. Our study estimates the lifetime clinical outcomes, quality of life, and healthcare costs of BPD and associated complications.
We developed a microsimulation model to estimate lifetime clinical and economic burden of BPD among extreme preterm infants (≤28 weeks gestational age at birth) and validated it against the best available Canadian data. We further estimate the cumulative incidence of major complications associated with BPD, differentiated by BPD severity and gestational age category.
We find, on average, patients with BPD and resulting complications will incur over CAD$700,000 in lifetime health systems costs. We also find the average life expectancy of BPD patients to be moderately less than that of the general population and significant reductions in quality-adjusted life year due to major complications. Healthcare utilization and quality of life measures vary dramatically according to BPD severity, suggesting significant therapeutic headroom for interventions that can prevent or mitigate the effects of BPD for patients.
Our study adds a significant expansion of existing evidence by presenting the lifetime burden of BPD based on key patient characteristics. Given the extreme cost burden at the earliest stage of life and lifetime negative impact on quality of life, there is larger headroom for investment in prevention and mitigation of severe BPD than is currently available.
支气管肺发育不良（BPD）是最严重的慢性肺部疾病之一，主要影响早产儿。人们普遍了解 BPD 对短期结局的重大影响，但对长期结局的证据甚少。我们的研究估计了 BPD 及其相关并发症的终身临床结局、生活质量和医疗保健成本。
我们开发了一个微观模拟模型，以估计极早产儿（出生时胎龄≤28 周）中 BPD 的终身临床和经济负担，并根据加拿大最佳现有数据对其进行了验证。我们进一步估计了与 BPD 相关的主要并发症的累积发生率，并按 BPD 严重程度和胎龄类别进行了区分。
我们发现，平均而言，患有 BPD 及其相关并发症的患者将在一生中产生超过 70 万加元的卫生系统成本。我们还发现，BPD 患者的平均预期寿命略低于一般人群，并且由于主要并发症而导致的质量调整生命年显著减少。根据 BPD 的严重程度，医疗保健的利用和生活质量的衡量标准有很大差异，这表明对于那些可以预防或减轻 BPD 对患者影响的干预措施，存在着显著的治疗空间。
我们的研究通过根据关键患者特征提出 BPD 的终身负担，对现有证据进行了重要扩展。鉴于生命早期极高的成本负担以及对生活质量的终身负面影响，与目前可用的投资相比，在预防和减轻严重 BPD 方面有更大的空间。
