2014 - 2019年德国儿童肺炎球菌疾病的医疗资源利用情况及成本：一项回顾性队列研究
Healthcare resource utilization and cost of pneumococcal disease in children in Germany, 2014-2019: a retrospective cohort study.
作者信息
Hu Tianyan, Podmore Bélène, Barnett Rosemarie, Beier Dominik, Galetzka Wolfgang, Qizilbash Nawab, Heckl Dennis, Boellinger Timo, Weaver Jessica
机构信息
Merck & Co., Inc., Rahway, NJ, USA.
OXON Epidemiology, London, UK.
出版信息
Pneumonia (Nathan). 2023 Mar 25;15(1):7. doi: 10.1186/s41479-023-00105-9.
BACKGROUND
Since the introduction of higher valency pneumococcal conjugate vaccines in 2009, recent estimates on the economic burden of pediatric pneumococcal disease (PD) in Germany have been lacking. This study estimates healthcare resource utilization (HCRU) and medical cost associated with PDs in children < 16 years old in Germany from 2014-2019.
METHODS
A nationally representative sample from the Institute for Applied Health Research (InGef) German claims database was used, covering approximately 5% of the total German population. Episodes of pneumococcal pneumonia (PP), all-cause pneumonia (ACP), invasive pneumococcal disease (IPD), and acute otitis media (AOM) in children aged < 16 years were identified using ICD-10-GM codes. HCRU was estimated from annual rates of outpatient visits, outpatient antibiotic prescriptions and inpatient admissions, divided by person-years (PY) at-risk. Average direct medical costs per episode were estimated as the total cost of all HCRU, divided by the total number of episodes. The Mann-Kendall test was used to assess monotonic time trends from 2014-2019.
RESULTS
During 2014-2019, 916,805 children aged < 16 years were followed up for a total of 3,608,716 PY. The average costs per episode for out-versus inpatient care associated with PP and ACP were €67 (95% CI 58-76) versus €2,606 (95% CI 1,338-3,873), and €63 (95% CI 62-63) versus €620 (95% CI 598-641), respectively. For IPD, the average medical cost per episode for out-versus inpatients were €30 (95% CI 19-42) versus €6,051 (95% CI 3,323-8,779), respectively. There were no significant trends in HCRU or costs for IPD or pneumonia over the study period, except for a significant reduction in ACP outpatient visits. A significant decrease in rate of outpatient visits and antibiotic prescribing for recurrent AOM was observed, in addition to an increase in rates of hospital admissions for simple AOM. This was paralleled by a significant increase in inpatient costs per episode for treating AOM overall, and simple AOM, over the study period.
CONCLUSIONS
The HCRU and cost per episode of pneumonia and IPD did not vary significantly from 2014-2019, but increased for AOM. The economic burden of pneumonia, IPD, and AOM remains substantial in Germany.
背景
自2009年引入更高价次的肺炎球菌结合疫苗以来，德国缺乏对儿童肺炎球菌疾病（PD）经济负担的最新估计。本研究估计了2014 - 2019年德国16岁以下儿童与肺炎球菌疾病相关的医疗资源利用（HCRU）和医疗费用。
方法
使用来自应用健康研究所（InGef）德国索赔数据库的全国代表性样本，覆盖德国总人口的约5%。使用ICD - 10 - GM编码识别16岁以下儿童的肺炎球菌肺炎（PP）、全因肺炎（ACP）、侵袭性肺炎球菌疾病（IPD）和急性中耳炎（AOM）发作。HCRU通过门诊就诊、门诊抗生素处方和住院入院的年发生率估计，并除以风险人年数（PY）。每发作一次的平均直接医疗费用估计为所有HCRU的总成本除以发作总数。使用曼 - 肯德尔检验评估2014 - 2019年的单调时间趋势。
结果
在2014 - 2019年期间，对916,805名16岁以下儿童进行了随访，总计3,608,716人年。与PP和ACP相关的门诊与住院护理每发作一次的平均费用分别为67欧元（95%CI 58 - 76）与2,606欧元（95%CI 1,338 - 3,873），以及63欧元（95%CI 62 - 63）与620欧元（95%CI 598 - 641）。对于IPD，门诊与住院患者每发作一次的平均医疗费用分别为30欧元（95%CI 19 - 42）与6,051欧元（95%CI 3,323 - 8,779）。在研究期间，IPD或肺炎的HCRU或费用没有显著趋势，除了ACP门诊就诊显著减少。观察到复发性AOM的门诊就诊率和抗生素处方率显著下降，此外简单AOM的住院率增加。这与研究期间治疗AOM总体以及简单AOM的每次住院费用显著增加相平行。
结论
2014 - 2019年肺炎和IPD的HCRU和每次发作费用没有显著变化，但AOM有所增加。在德国，肺炎、IPD和AOM的经济负担仍然很大。
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