Department of Public Health and Primary Care, Interuniversity Centre for Health Economics Research (I-CHER), Ghent University, Gent, Belgium.
Infectious Diseases Department, University Hospital Raymond Poincaré, APHP, Université de Versailles Saint-Quentin-Paris Saclay, Garches, France.
Eur J Public Health. 2023 Aug 1;33(4):668-674. doi: 10.1093/eurpub/ckad045.
A proportion of patients with Lyme borreliosis (LB) report long-term persisting signs and symptoms, even after recommended antibiotic treatment, which is termed post-treatment Lyme disease syndrome (PTLDS). Consensus on guidance regarding diagnosis and treatment is currently lacking. Consequently, patients suffer and are left searching for answers, negatively impacting their quality of life and healthcare expenditure. Yet, health economic data on PTLDS remain scarce. The aim of this article is therefore to assess the cost-of-illness related to PTLDS, including the patient perspective.
PTLDS patients (N = 187) with confirmed diagnosis of LB were recruited by a patient organization. Patients completed a self-reported questionnaire on LB-related healthcare utilization, absence from work and unemployment. Unit costs (reference year 2018) were obtained from national databases and published literature. Mean costs and uncertainty intervals were calculated via bootstrapping. Data were extrapolated to the Belgian population. Generalized linear models were used to determine associated covariates with total direct costs and out-of-pocket expenditures.
Mean annual direct costs amounted to €4618 (95% CI €4070-5152), of which 49.5% were out-of-pocket expenditures. Mean annual indirect costs amounted to €36 081 (€31 312-40 923). Direct and indirect costs at the population level were estimated at €19.4 and 151.5 million, respectively. A sickness or disability benefit as source of income was associated with higher direct and out-of-pocket costs.
The economic burden associated with PTLDS on patients and society is substantial, with patients consuming large amounts of non-reimbursed healthcare resources. Guidance on adequate diagnosis and treatment of PTLDS is needed.
一些莱姆病（LB）患者在接受推荐的抗生素治疗后仍长期持续存在症状和体征，这种情况被称为治疗后莱姆病综合征（PTLDS）。目前，对于诊断和治疗的指导意见尚未达成共识。因此，患者饱受病痛折磨，四处求医，生活质量受到负面影响，医疗支出也相应增加。然而，PTLDS 的健康经济学数据仍然很少。本文旨在评估与 PTLDS 相关的疾病经济负担，包括患者视角。
通过患者组织招募了已确诊 LB 的 PTLDS 患者（N=187）。患者填写了一份关于 LB 相关医疗保健利用、缺勤和失业的自我报告问卷。单位成本（参考年为 2018 年）来自国家数据库和已发表的文献。通过自举法计算平均成本和不确定性区间。数据外推至比利时人群。使用广义线性模型确定与总直接成本和自付费用相关的协变量。
平均年直接成本为 4618 欧元（95%CI 4070-5152），其中 49.5%为自付费用。平均年间接成本为 36081 欧元（31312-40923）。在人群层面，直接和间接成本分别估计为 1940 万欧元和 1.515 亿欧元。收入来源为疾病或残疾津贴与较高的直接和自付费用相关。
PTLDS 给患者和社会带来的经济负担相当大，患者消耗了大量未报销的医疗资源。需要对 PTLDS 的适当诊断和治疗提供指导。
