Vadlamudi Nirma Khatri, Sadatsafavi Mohsen, Patrick David M, Rose Caren, Hoang Linda, Marra Fawziah
Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada.
Respiratory Evaluation Sciences Program, The University of British Columbia, Vancouver, BC, Canada.
Value Health. 2022 Sep;25(9):1510-1519. doi: 10.1016/j.jval.2022.03.017. Epub 2022 Apr 21.
Invasive pneumococcal disease (IPD) and a variety of clinical syndromes caused by pneumococci, such as acute otitis media (AOM), acute sinusitis (AS), and community-acquired pneumonia (CAP), cause a substantial burden on healthcare systems. Few studies have explored the short-term financial burden of pneumococcal disease after the 13-valent pneumococcal conjugate vaccine (PCV13) introduction in the infant immunization programs. This population-based study evaluated changes in costs associated with healthcare utilization for pneumococcal disease after the PCV13 introduction in the infant immunization program in British Columbia, Canada.
Individuals with pneumococcal disease were identified using provincial administrative data for the 2000 to 2018 period. Total direct healthcare costs were determined using case-mix methodology for hospitalization and fee-for-service codes for outpatient visits and medications dispensed. Costs were adjusted to 2018 Canadian dollars. Changes in the annual healthcare costs were evaluated across vaccine eras (pre-PCV13, 2000-2010; PCV13, 2011-2018) using generalized linear models, adjusting for the 7-valent pneumococcal conjugate vaccine program (2004-2010).
During the 19-year study period, pneumococcal disease resulted in 6.3 million cases among 85 million total patient-years, resulting in total healthcare costs of $7.9 billion. More than 6.2 million cases were treated in outpatient setting, costing $0.65 billion (8% of total costs associated with pneumococcal disease treatment), whereas 370 000 hospitalized cases were 3% of all cases, which accrued $7.25 billion (92% of total costs) in costs. Healthcare costs for all studied infections nearly doubled over the study period from $248 million in 2000 to $476 million in 2018 (P = .003). In contrast, there were large declines in total annual costs in the PCV13 era for IPD (adjusted relative rate (aRR) 0.73; 95% confidence interval [CI] 0.56-0.95; P = .032), AOM (aRR 0.70; 95% CI 0.59-0.83; P = .001), and AS (aRR 0.68; 95% CI 0.54-0.85; P = .004) compared with the pre-PCV13 era. Total costs increased marginally in the PCV13 era for all-cause CAP (aRR 1.04; 95% CI 0.94-1.15; P = .484).
This study confirms a temporal association in declining economic burden for IPD, AOM, and AS after the PCV13 introduction. Nevertheless, the total economic burden continues to be high in the PCV13 era, mainly driven by increasing CAP costs.
侵袭性肺炎球菌病（IPD）以及由肺炎球菌引起的多种临床综合征，如急性中耳炎（AOM）、急性鼻窦炎（AS）和社区获得性肺炎（CAP），给医疗系统带来了沉重负担。在婴儿免疫计划中引入13价肺炎球菌结合疫苗（PCV13）后，很少有研究探讨肺炎球菌病的短期经济负担。这项基于人群的研究评估了加拿大不列颠哥伦比亚省婴儿免疫计划中引入PCV13后，与肺炎球菌病医疗利用相关的成本变化。
利用2000年至2018年期间的省级行政数据识别肺炎球菌病患者。使用病例组合方法确定住院的总直接医疗成本，并使用门诊就诊和配药的服务收费代码。成本调整为2018年加拿大元。使用广义线性模型评估各疫苗时代（PCV13之前，2000 - 2010年；PCV13，2011 - 2018年）年度医疗成本的变化，并对7价肺炎球菌结合疫苗计划（2004 - 2010年）进行调整。
在19年的研究期间，肺炎球菌病在8500万总患者年中导致630万例病例，产生的总医疗成本为79亿美元。超过620万例病例在门诊治疗，花费6.5亿美元（占肺炎球菌病治疗总成本的8%），而37万例住院病例占所有病例的3%，产生了72.5亿美元（占总成本的92%）的成本。在研究期间，所有研究感染的医疗成本几乎翻了一番，从2000年的2.48亿美元增至2018年的4.76亿美元（P = 0.003）。相比之下，在PCV13时代，IPD（调整相对率（aRR）0.73；95%置信区间[CI] 0.56 - 0.95；P = 0.032）、AOM（aRR 0.70；95% CI 0.59 - 0.83；P = 0.001）和AS（aRR 0.68；95% CI 0.54 - 0.85；P = 0.004）的年度总成本大幅下降。在PCV13时代，全因CAP的总成本略有增加（aRR 1.04；95% CI 0.94 - 1.15；P = 0.484）。
本研究证实了引入PCV13后IPD、AOM和AS经济负担下降的时间关联。然而，在PCV13时代，总经济负担仍然很高，主要由CAP成本增加驱动。
