成人呼吸道合胞病毒及急性呼吸道感染的成本与并发症：德国理赔数据库分析
Costs and Complications of Respiratory Syncytial Virus and Acute Respiratory Infections in the Adult Population: Analysis of a German Claims Database.
作者信息
Marijic Pavo, Kliemt Roman, Krammer Martin, Kolb Nikolaus, Last Theo, Ambrosch Andreas, Ewig Santiago, Koczulla Rembert, Schelling Jörg, Vogelmeier Claus, Waize Maria, Stierl Manuela, Fonseca Maria João, Pedron Sara, Marijam Alen
机构信息
GSK, Munich, Germany.
WIG2 Scientific Institute for Health Economics and Health System Research, Leipzig, Germany.
出版信息
Pharmacoecon Open. 2025 May;9(3):445-459. doi: 10.1007/s41669-025-00565-3. Epub 2025 Mar 19.
BACKGROUND
Respiratory syncytial virus (RSV) infections pose health and economic burdens to adults. Using claims data, we estimated RSV-associated costs, healthcare resource utilization (HCRU), and complication rates from patients of a nationwide German health insurance database.
METHODS
We analyzed confirmed RSV, RSV-possible, and acute respiratory infection (ARI) cohorts, plus 1:1 matched control cohorts of individuals ≥ 18 years from 2010 to 2019. Matching was performed separately for patients 18-49, 50-59, and ≥ 60 years. Medical costs, HCRU, and sick leave were assessed for inpatients and outpatients. Complications were compared between cases and controls, and logistic regression assessed odds ratios (ORs) for risk.
RESULTS
Altogether, 2668 confirmed RSV index episodes occurred. In ≥ 60-year-olds, 862 episodes incurred mean excess costs of €3773 (95% confidence interval [CI]: €2956-€4591) per episode during the index quarter and €3286 (95% CI: €1841-€4732) in the following four quarters. Mean costs were €5553 per episode for inpatients and €116 for outpatients. In ≥ 60-year-olds, risk for congestive heart failure hospitalization (OR 2.3; 95% CI: 1.4-3.8), exacerbation of asthma (OR 6.0; 95% CI: 1.7-20.9), and chronic obstructive pulmonary disease (OR 3.9; 95% CI: 2.6-5.8) were higher for confirmed RSV than controls. In younger groups, costs, HCRU, and complications were also higher in cases than controls. The complication frequencies increased with age. RSV-possible episodes incurred mean excess costs of €615 (95% CI: €605-€626) during the index quarter and €610 (95% CI: €583-€637) during the following four quarters, while in the ARI cohort, the excess costs were €1003 (95% CI: €991-€1015) during the index quarter and €1003 (95% CI: €973-€1032) in the following four quarters. For all three cohorts, individuals who had comorbidities, were immunocompromised, or living in long-term care facilities incurred higher costs.
CONCLUSIONS
Confirmed RSV is associated with high excess costs - especially in hospital settings - and HCRU. Complication risk increased with RSV presence.
背景
呼吸道合胞病毒（RSV）感染给成年人带来健康和经济负担。我们利用索赔数据，估算了德国全国健康保险数据库中患者与RSV相关的成本、医疗资源利用（HCRU）情况以及并发症发生率。
方法
我们分析了确诊为RSV、可能感染RSV以及急性呼吸道感染（ARI）的队列，外加2010年至2019年18岁及以上个体的1:1匹配对照队列。18至49岁、50至59岁以及60岁及以上的患者分别进行匹配。对住院患者和门诊患者的医疗成本、HCRU及病假情况进行评估。比较病例组和对照组的并发症情况，并通过逻辑回归评估风险比值比（OR）。
结果
共发生2668例确诊的RSV指数发作病例。在60岁及以上人群中，862例发作病例在指数季度每例平均额外成本为3773欧元（95%置信区间[CI]：2956欧元 - 4591欧元），在随后四个季度为3286欧元（95% CI：1841欧元 - 4732欧元）。住院患者每例平均成本为5553欧元，门诊患者为116欧元。在60岁及以上人群中，确诊为RSV的患者发生充血性心力衰竭住院的风险（OR 2.3；95% CI：1.4 - 3.8）、哮喘加重（OR 6.0；95% CI：1.7 - 20.9）以及慢性阻塞性肺疾病（OR 3.9；95% CI：2.6 - 5.）高于对照组。在较年轻组中，病例组的成本、HCRU及并发症也高于对照组。并发症发生率随年龄增加而升高。可能感染RSV的发作病例在指数季度平均额外成本为615欧元（95% CI：605欧元 - 626欧元），在随后四个季度为610欧元（95% CI：583欧元 - 637欧元），而在ARI队列中，指数季度额外成本为1003欧元（95% CI：991欧元 - 1015欧元），随后四个季度为1003欧元（95% CI：973欧元 - 1032欧元）。对于所有三个队列，患有合并症、免疫功能低下或居住在长期护理机构的个体成本更高。
结论
确诊的RSV与高额额外成本相关，尤其是在医院环境中，以及HCRU。并发症风险随RSV感染的存在而增加。
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