Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK.
ReSViNET Foundation, Zeist, the Netherlands.
J Glob Health. 2022 Nov 8;12:04096. doi: 10.7189/jogh.12.04096.
Acute respiratory infections (ARIs) accounted for an estimated 3.9 million deaths worldwide in 2015, of which 56% occurred in adults aged 60 years or older. We aimed to identify the cost of ARI management in older adults (≥50 years) in order to develop an evidence base to assist decision-making for resource allocation and inform clinical practice.
We searched 8 electronic databases including Global Health, Medline and EMBASE for studies published between January 1, 2000 and December 31, 2021. Total management costs per patient per ARI episode were extracted and meta-analysis was conducted by World Health Organization (WHO) region and World Bank income level. All costs were converted and inflated to Euros (€) (2021 average exchange rate). The quality of included studies and the potential risk of bias were evaluated.
A total of 42 publications were identified for inclusion, reporting cost data for 8 082 752 ARI episodes in older adults across 20 countries from 2001 to 2021. The majority (86%) of studies involved high-income countries based in Europe, North America and Western Pacific. The mean cost per episode was €17 803.9 for inpatient management and €128.9 for outpatient management. Compared with costs reported for patients aged <65 years, inpatient costs were €154.1, €7 018.8 and €8 295.6 higher for patients aged 65-74 years, 75-84 years and over 85 years. ARI management of at-risk patients with comorbid conditions and patients requiring higher level of care, incurred substantially higher costs for hospitalization: €735.9 and €1317.3 respectively.
ARIs impose a substantial economic burden on health systems, governments, patients and societies. This study identified high ARI management costs in older adults, reinforcing calls for investment by global health players to quantify and address the scale of the challenge. There are large gaps in data availability from low-income countries, especially from South East Asia and Africa regions.
2015 年，全球有估计 390 万人死于急性呼吸道感染（ARI），其中 56%发生在 60 岁或以上的成年人中。我们旨在确定老年人（≥50 岁）中 ARI 管理的成本，以便为资源分配的决策提供依据，并为临床实践提供信息。
我们在 8 个电子数据库中进行了搜索，包括全球卫生、医学文献分析与联机数据库和 Embase，以获取 2000 年 1 月 1 日至 2021 年 12 月 31 日期间发表的研究。从每个 ARI 发作的每位患者中提取了总管理成本，并按世界卫生组织（WHO）区域和世界银行收入水平进行了荟萃分析。所有成本均已转换并换算为欧元（€）（2021 年平均汇率）。评估了纳入研究的质量和潜在的偏倚风险。
共确定了 42 篇出版物，报告了 20 个国家的 8082752 例老年人 ARI 发作的成本数据，这些研究来自 2001 年至 2021 年。大多数（86%）研究来自欧洲、北美和西太平洋的高收入国家。每例住院管理的平均费用为 17803.9 欧元，门诊管理的费用为 128.9 欧元。与报告的 65 岁以下患者的成本相比，65-74 岁、75-84 岁和 85 岁以上患者的住院费用分别高出 154.1、7018.8 和 8295.6 欧元。患有合并症的高危患者和需要更高护理水平的患者的 ARI 管理费用，住院费用分别大幅增加了 735.9 和 1317.3 欧元。
ARI 给卫生系统、政府、患者和社会带来了巨大的经济负担。本研究确定了老年人中 ARI 管理的高成本，这再次呼吁全球卫生参与者进行投资，以量化和应对这一挑战的规模。来自低收入国家，特别是东南亚和非洲地区的数据可用性存在很大差距。
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