Figures
- FIGURE 1
Range of bronchiectasis exacerbations in the previous year, per year and in the first and second years of follow-up. #: Two studies reported significant differences in the number of exacerbations experienced in the previous year across individual aetiologies. Study 1 [90]: Patients with idiopathic bronchiectasis had significantly fewer exacerbations in the previous year compared with other aetiologies (primary ciliary dyskinesia (PCD), COPD and post-infectious) (p<0.021). Study 2 [33]: significant difference between post-tuberculosis (TB) bronchiectasis (mean: 2.8) and other aetiologies excluding idiopathic bronchiectasis (mean: 1.7) (p<0.05).
Tables
- TABLE 1
Prevalence and severity of bronchiectasis symptoms overall, in children, during exacerbations and in individual bronchiectasis aetiologies
Symptom Prevalence overall (range of %) Prevalence in children (range of %) Prevalence during exacerbationaor in frequent exacerbators (range of %) Prevalence by aetiology (% or range of %) Number of studies Dyspnoea prevalenceb 7.1–78.1 (26.1–33.5) 19.7–81.3 83.9–87.2c
30.0–32.4d– 13 Dyspnoea severity MRC scoree (mean or median) 1.8–3.0f
0.0–3.0g– 0.0–2.0h Post-TB (2.8), idiopathic (2.4), other aetiologies (2.3)i 20 MRC score: 0 9.0 – – CF (58.3)j 2 MRC score: 1 22.4–37.5 – – CF (30.3)j 3 MRC score: 2 19.9–43.3 – – CF (8.3)j 3 MRC score: 3 20.4–22.4 – – CF (3.0)j 3 MRC score: 4 3.0–14.3 – – – 4 MRC score: 5 5.0–7.9 – – 2 mMRC scorek
(mean or median)1.1–2.3f
1.0–2.0g– 1.8l–2.2m Post-TB (2.0), post-infectious (2.0), asthma (2.0), COPD (2.0), other aetiologies (2.0), idiopathic (1.0), ABPA (1.0)n 28 Idiopathic or post-infectious (2.4)o mMRC score: 0 7.7–65.7 – – – 6 mMRC score: 1 18.2–51.6 – – – 6 mMRC score: 2 3.6–34.2 – – – 6 mMRC score: 3 2.1–34.2 – – – 6 mMRC score: 4 0.7–9.1 – – – 5 Cough 24.0–98.5 (25.8–95.0) 41.9–98.3 78.7–84.9c
94.5–95.0dPCD (91.0)p, idiopathic (81.3), AATD (72.4), CVID (64.7) 32 Wheezing 15.0–65.3 (15.0–16.0) 1.5–52.5 – PCD (70.5)q, idiopathic (29.1), AATD (25.9), CVID (33.3) 15 Wheezing in previous 12 months – 30.9–47.7 – – 3 Sputum production 22.0–92.7 (41.4–92.7) 6.1–77.9 85.1r
43.2–62.5dCOPD (65.2)s, other aetiologies (50.8) 26 Mucoid sputum 9.1–46.4 (24.2–46.4) – – CF (12.9)j 13 Mucopurulent sputum 17.7–80.1 (17.7–44.8) – – CF (37.1)j 14 Purulent sputum 5.9–84.5 (5.9–84.5) – – CF (40.9)j 14 24-hour sputum volume (mL, mean or median) 11.4–91.2f
5.0–21.0g– – COPD (20.0), post-TB (10.0), post-infectious (10.0), asthma (10.0), other aetiologies (10.0), idiopathic (5.0), ABPA (5.0)n 14 CF (25.8)j 24-hour sputum weight (g, mean or median) 10.8–41.8f
15.4–21.1g– – Idiopathic or post-infectious (15.5–37.1)o 8 Haemoptysis 2.4–63.5
(13.2–40.5)6.7–16.3 8.0u
8.5–13.9c
17.6vPost-TB (30.4)t, other aetiologies (11.8) 33 Idiopathic (28.6), post-TB (25.4), ABPA (14.3), PCD (14.3), COPD (11.1), post-pneumonia (10.5)w All data are percentages except where mean or median are indicated. Parentheses in the “Prevalence overall” column indicate data from larger or multicentre studies only. All data from individual studies are available in the supplemental Excel file. a: A study reported increased dyspnoea during an exacerbation in 77.5% of patients, increased cough during exacerbation in 85.0% of patients and increased sputum purulence and sputum volume in 83.4% and 72.2% of patients, respectively [25]. b: Dyspnoea, only when active or exercising, was reported in two studies and ranged from 11.0 to 54.0% [16, 26]. c: Single study in adults with noncystic fibrosis bronchiectasis (NCFBE) during a pneumonic or nonpneumonic exacerbation. No significant difference in the prevalence of dyspnoea (p=0.599), cough (p=0.356) or haemoptysis (p=0.422) was reported between pneumonic and nonpneumonic exacerbations [27]. d: Single study in children with NCFBE during a virus-positive or virus-negative exacerbation. No significant difference in the prevalence of dyspnoea (p=0.81) or wet cough (p=0.93) was reported between virus-positive and -negative exacerbations; however, virus-negative exacerbations were significantly associated with sputum production (p=0.09) [28]. e: The Medical Research Council (MRC) dyspnoea scale assesses the impact of breathlessness on an individual. MRC scores range from 1 to 5, with higher scores indicating more severe dyspnoea [29]. The grading is as follows: 1=not troubled by breathlessness except on strenuous exercise; 2=short of breath when hurrying on a level or when walking up a slight hill; 3=walks slower than most people on the level, stops after a mile or so, or stops after 15 min walking at own pace; 4=stops for breath after walking 100 yards, or after a few minutes on level ground; 5=too breathless to leave the house, or breathless when dressing/undressing. f: Studies reporting mean. g: Studies reporting median. h: Median MRC dyspnoea score reported in a single study of patients admitted to hospital for an exacerbation [30]. In another study, patients hospitalised for an exacerbation during the 1-year follow-up period had significantly higher MRC dyspnoea scores compared with those who were not hospitalised for an exacerbation during the same follow-up period (p=0.004) [31]. i: Patients with post-tuberculosis (TB) bronchiectasis had significantly higher MRC scores compared with idiopathic bronchiectasis and other aetiologies (not post-TB or idiopathic) (p<0.05 for all comparisons) [32]. j: Study reporting in patients with cystic fibrosis (CF)-related bronchiectasis; no comparison with other aetiologies [33]. k: The modified MRC (mMRC) dyspnoea scale is a slightly modified version of the MRC dyspnoea scale. mMRC scores range from 0 to 4, with higher scores indicating more severe dyspnoea [34]. Grading is as follows: 0=I only get breathless with strenuous exercise; 1=I get short of breath when hurrying on level ground or walking up a slight hill; 2=on level ground, I walk slower than people of the same age because of breathlessness, or have to stop for breath when walking at my own pace; 3=I stop for breath after walking about 100 yards or after a few minutes on level ground; 4=I am too breathless to leave the house or I am breathless when dressing. l: In a single study, the mean mMRC dyspnoea score was significantly higher in frequent exacerbators (≥2 exacerbations per year) compared with nonfrequent exacerbators (p<0.001) [35]. m: In a single study, the mean mMRC dyspnoea score was significantly higher in frequent exacerbators (≥2 exacerbations⋅year−1 or ≥1 hospitalisation⋅year−1) compared with nonfrequent exacerbators (p<0.0001) [36]. n: No statistical analyses performed [19]. “Other” includes rheumatoid arthritis, primary ciliary dyskinesia (PCD), gastro-oesophageal reflux disease and nontuberculous mycobacteria infection. o: Studies reporting in patients with idiopathic or post-infectious bronchiectasis; no comparison with other aetiologies [37, 38]. p: Patients with PCD-related bronchiectasis had a significantly higher prevalence of cough compared with patients with alpha-1 antitrypsin deficiency (AATD)- and common variable immunodeficiency (CVID)-related bronchiectasis (p=0.012), but not idiopathic bronchiectasis [39]. q: Patients with PCD-related bronchiectasis had a significantly higher prevalence of wheezing compared with idiopathic, AATD-associated and CVID-associated bronchiectasis (p<0.0001) [39]. r: Single study in adults with NCFBE hospitalised for an exacerbation [40]. s: A significantly greater proportion of patients with COPD-related bronchiectasis had daily expectoration compared with other aetiologies (p=0.001) [41]. t: In patients admitted to hospital for an exacerbation, significantly more patients with post-TB bronchiectasis had haemoptysis compared with other aetiologies (p=0.006) [30]. u: Single study in adults with NCFBE (PCD and primary immunodeficiency excluded) during an exacerbation [25]. v: Single study in adults hospitalised for an exacerbation [30]. w: In patients admitted to a tertiary care centre; no statistical analyses performed [42]. –: Symptoms for which data were not reported in children, during an exacerbation or in individual aetiologies; ABPA: allergic bronchopulmonary aspergillosis.
- TABLE 2
Patient-reported outcome scores in patients with bronchiectasis overall and in individual bronchiectasis aetiologies
Patient-reported outcome Score description Score overall Score by aetiology Number of studies SGRQ Total score Scores range from 0 to 100, with higher scores indicating more limitations 26.5–66.3a
(31.6–53.0)a
29.0–59.0b
(29.0–59.0)bIdiopathic or post-infectious (39.7–43.2)c 35 NCFBE (27.4), CF (25.4)d IBD (54.3), RA (46.8), ABPA (45.8), idiopathic or post-infectious (42.0), post-TB (41.8), other aetiologies (49.6)e Symptoms score 32.3–64.0a
(56.8–61.0)aIdiopathic or post-infectious (61.0)b 17 NCFBE (46.3), CF (40.1)d Activities score 25.9–59.7a NCFBE (24.9), CF (27.0)d 14 Impacts score 18.2–63.0a NCFBE (22.6), CF (19.9)d 14 QoL-B Respiratory symptoms score QoL-B comprises eight domains; scores for each domain can range between 0 and 100, with higher scores indicating fewer symptoms or better functioning and HRQoL 23.2–91.4a
(54.0–57.8)a
65.0–68.6bIBD (54)f, other aetiologies (58) 21 Immunodeficiency (63.5)g Idiopathic or post-infectious (51.2)c AATD (58.7)h Post-TB (66.7), ABPA (66.7), post-infectious (63.0), asthma (63.0), idiopathic (59.3), COPD (57.5), other aetiologies (51.9)i Physical functioning score 23.9–67.5a
(42.5–55.7)a
53.5–83.0b– 10 Vitality score 22.8–63.8a
(48.7–53.1)a
44.0–56.0b– 9 Role functioning score 33.3–82.3a
(59.2–64.7)a
66.7–73.3b– 11 Emotional functioning score 31.3–87.9a
(76.9–87.9)a
79–83.3b– 10 Social functioning score 30.8–72.4a
(51.3–65.0)a
50.0–75.0b– 11 Treatment burden score 32.2–76.0a
(63.2–66.8)a
56.0–78.0b– 11 Health perception score 35.5–68.8a
(42.4–47.3)a
33.0–60.0b– 11 LCQ Total score Each domain is scored from 1 to 7 and domain scores are added together to obtain a total score that can range from 3 to 21. Higher scores indicate a better quality of life 10.0–17.5a
(13.4–15.3)a
11.0–16.6b
(11.0–14.0)bCF (16.6)j 24 Physical score 4.5–5.7a
(5.0)aCF (5.3)j 8 Psychological score 4.8–5.9a
(5.0)aCF (5.3)j 8 Social score 4.6–6.1a
(5.3)aCF (5.7)j 8 CAT CAT score Scores range from 0 to 40, with higher scores denoting more severe impacts 14.3–21.2a
(14.8)aIdiopathic or post-infectious (19.1–26.0)c 7 BHQ BHQ score Scores range from 0 to 100; higher scores indicate better health status 39.0–61.9a
(61.9)a
53.5b– 5 HRQoL in children PC-QoLk PC-QoL score Scores range from 1 (low quality of life) to 7 (high quality of life) 4.4–6.5b
(4.4–6.5)b– 5 CC-QoLk CC-QoL score Scores range from 1 (low quality of life) to 7 (high quality of life) 6.5b
(6.5)b– 1 PedsQL Child-specific PedsQL score Scores range from 0 to 100, with higher scores indicating better quality of life Significantly lower in children with bronchiectasis compared with age-matched controlsl – 1 Parent-proxy PedsQL score Anxiety and depression HADS HADS-A score Each subscore ranges from 0 to 21, with a higher score indicating more severe anxiety or depressionm 4.4–7.0a,n,o
(4.4–4.9)aNCFBE (7.0), CF (5.5)d 8 HADS-D score 2.9–5.6a,n,o
(3.1–5.6)aNCFBE (4.4), CF (3.6)d 8 PHQ-9 PHQ-9 score Scores range from 0 to 27, with higher scores indicating more severe depressionp 4.8–11.1q – 1 Fatigue FSS FSS score Comprises nine categories (each are scored from 0 to 7); total score ranges from 9 to 63r 20.0–39.7s
4.7–5.0t– 3 Parentheses in the “Score by aetiology” column indicate data from larger or multicentre studies only. All data from individual studies are available in the supplemental Excel file. aS: Studies reporting mean. b: Studies reporting median. c: Studies reporting in patients with idiopathic or post-infectious bronchiectasis; no comparison with other aetiologies [37, 44–47]. d: No significant difference between patients with noncystic fibrosis bronchiectasis (NCFBE) and cystic fibrosis (CF)-related bronchiectasis (no p-value reported) [48]. e: No significant difference between aetiologies (p=0.1) [49]. “Other” includes none of the aforementioned aetiologies. f: Patients with inflammatory bowel disease (IBD)-related bronchiectasis had significantly worse Quality of Life–Bronchiectasis (QoL-B) respiratory symptom domain scores compared with patients with other aetiologies (p=0.02). The difference was greater when IBD-related bronchiectasis was compared with idiopathic bronchiectasis alone (mean difference: 5.6 points; p=0.001) [50]. g: Patients with immunodeficiency-related bronchiectasis were found to have a significantly lower respiratory symptoms score according to QoL-B when compared with other aetiologies (mean difference: 3.5 points; p<0.0001) [51]. h: tudy reporting in patients with alpha-1 antitrypsin deficiency (AATD)-related bronchiectasis; no comparison with other aetiologies [52]. i: No statistical analyses were performed in this study [19]. “Other” includes rheumatoid arthritis (RA), primary ciliary dyskinesia, gastro-oesophageal reflux disease and nontuberculosis (TB) mycobacteria infection. j: Study reported in patients with CF-related bronchiectasis; no comparison with other aetiologies [33]. k: The parent cough-specific quality of life (PC-QoL) and the chronic cough-specific quality of life (CC-QoL) are instruments for assessing the impact of a child's chronic cough on quality of life; however, the PC-QoL is completed by the parent or caregiver of the child, whereas the CC-QoL is completed by the child themselves. l: Single study comparing health-related quality of life (HRQoL) in children with bronchiectasis with age-matched controls with no diagnosis of a respiratory condition [53]. m: Scores of ≥8 generally reflect the presence of anxiety or depression, with scores between 8–10, 11–14 and 15–21 reflecting mild, moderate and severe anxiety or depression, respectively. n: In a study in which the presence of anxiety (Hospital Anxiety and Depression Scale–Depression (HADS)-A ≥8) or depression (HADS-D ≥8) was an inclusion criterion, the median HADS-A score was 10 (indicating mild anxiety) and the median HADS-D score was 11 (indicating moderate depression) [54]. o: In one study, mean HADS-A and HADS-D scores were found to be significantly higher in patients with bronchiectasis (HADS-A: 7.0; HADS-D: 5.3) compared with matched healthy controls (HADS-A: 4.1; HADS-D: 3.5), indicating more severe anxiety and depression in patients with bronchiectasis (p<0.001 for both comparisons) [55]. p: Scores of 0–4, 5–9, 10–14, 15–19 and 20–27 indicate minimal/no, mild, moderate, moderately severe and severe depression, respectively. q: Mean Nine-question Patient Health Questionnaire (PHQ-9) scores were reported in a single study and ranged from 4.8 (minimal/no depression) in patients with mild bronchiectasis to 11.1 (moderate depression) in patients with severe bronchiectasis [56]. r: Scores ≥36 indicate that a patient may be suffering from fatigue, with fatigue severity increasing with increasing score. s: In a study in which the total score was reported, the maximum mean Fatigue Severity Scale (FSS) score presented was reported in bronchiectasis patients with depression (PHQ-9 ≥10); this was significantly higher than the mean FSS score in patients without depression (20.0) (p<0.001) [56]. t: In studies in which the average score was reported (total score divided by 9) [57, 58]. –: Patient-reported outcomes for which data were not reported in individual aetiologies. ABPA: allergic bronchopulmonary aspergillosis; BHQ: Bronchiectasis Health Questionnaire; CAT: COPD Assessment Test; LCQ: Leicester Cough Questionnaire; PedsQL: Paediatric Quality of Life Inventory; SGRQ: St. George's Respiratory Questionnaire.
- TABLE 3
Healthcare resource utilisation (HCRU) in patients with bronchiectasis overall and in individual bronchiectasis aetiologies
HCRU overall HCRU by aetiology Number of studies Hospitalisations in the previous year (range of means or medians) 0.2–1.8a
(0.4–1.2)a
0.0bPost-infectious (0.8), other aetiologies (0.5), COPD (0.4), PCD (0.4), idiopathic (0.3)c 11 Post-TB (1.4), ABPA (1.3), idiopathic (1.2), post-pneumonia (1.2), immunodeficiency (1.2), rheumatic disease (0.7)d ≥1 hospitalisation (range of %) 12.0–77.5
(12.0–61.0)17 >1 hospitalisation (range of %) 7.0–59.9
(38.8)COPD (54.3), other aetiologies (47.2), idiopathic (45.4), post-TB (42.9), asthma (38.9), post-infectious (34.8), ABPA (29.1)e 3 Hospitalisations in the previous 2 years (range of means or medians) 0.5–0.7a
0.0–2.0b– 4 ≥1 hospitalisation (range of %) 10.0–39.0
(34.0–38.0)PCD (48.3), CVID (44.4), AATD (19.3), idiopathic (18.2)f 5 Hospitalisations per year (range of means) 0.03–1.3a
(0.3–1.1)aCOPD (1.0–1.5)g 6 ≥1 hospitalisation (range of %) 15.0–40.0
(32.0)– 2 Hospitalisations in first year of follow-up – ≥1 hospitalisation (range of %) 0.0–42.0
(14.0–42.0)– 4 ED visits in the previous year (range of means) 0.4–2.1a
(0.4)a– 2 ED visits per year (range of means) 0.4–1.3a
(0.4–1.3)a– 2 Outpatient visits per year (range of means) 6.8–21.0a
(6.8–21.0)a– 2 Length of stay (days) (range of means or medians) 6.9–17.4a
(6.9–11.0)a
4.0–47b,h
(4.0–12.0)b– 18 Parentheses in the “HCRU overall” column indicate data from larger or multicentre studies only. All data from individual studies are available in the supplemental Excel file. a: Studies reporting mean. b: Studies reporting median. c: No significant difference between aetiologies (no p-value given) [59]. d: No significant difference between aetiologies (p=0.134) [60]. Rheumatic disease includes rheumatoid arthritis (RA), systemic lupus erythematosus, primary Sjögren's syndrome, vasculitis and ankylosing spondylitis. e: No statistical analyses performed [19]. “Other” includes RA, primary ciliary dyskinesia (PCD), gastro-oesophageal reflux disease and non-tuberculosis (TB) mycobacteria infection. f: A significantly higher proportion of patients with PCD-related bronchiectasis were hospitalised in the previous 2 years compared with patients with alpha-1 antitrypsin deficiency (AATD)-related and idiopathic bronchiectasis; additionally, significantly more patients with common variable immunodeficiency (CVID)-related bronchiectasis were hospitalised compared with idiopathic bronchiectasis (p<0.0001 for both comparisons) [39]. g: Study reported in patients with COPD-related bronchiectasis of different severities; no comparison with other aetiologies [61]. h: Maximum value reported in patients admitted to the intensive care unit with severe bronchiectasis [62]. –: Measures of HCRU for which data were not reported in individual aetiologies; ABPA: allergic bronchopulmonary aspergillosis; ED: emergency department.
- TABLE 4
Bronchiectasis-related medical costs and indirect impacts and costs (individual studies)
Metric Cost Country Year Comparison with matched controls Reference Direct medical costs Overall costs Mean healthcare cost per patient per year (adults) Overall: €218
With the following comorbidities:
Malignancy: €4190
Myocardial infarction: €2142
Cerebrovascular disease: €1515
TB: €1055South Korea 2012–2017 – [104] Mean total direct medical expenditure per patient over a 3-year period €18 635
(For comparison purposes, this equates to ∼€6212 per year)Germany 2012–2015 Significantly higher total direct expenditure compared with matched controlsa (€14 237) (p<0.001) [85] Mean healthcare cost (maintenance treatment, exacerbations, ED visits and hospital admissions) per patient over a 1-year period (adults) Overall: €4672
COPD-related bronchiectasis: €7449
>2 exacerbations in study year: €7521
P. aeruginosa infectionb: €8654
Severe bronchiectasisc: €9999
≥2 hospitalisations in study year: €16 743Spain 2013 – [80] Mean cost of exacerbations (ED visits, hospital admissions and antibiotics) per patient over a 1-year period (adults) Overall: €1491
COPD-related bronchiectasis: €3026
>2 exacerbations in study year: €3397
Severe bronchiectasisc: €4306Spain 2013 – [80] Mean all-cause healthcare cost per patient in the year pre- and post-P. aeruginosa diagnosis (adults and children) Pre-diagnosis: €27 272
Post-diagnosis: €51 033
(Significant increase in cost; p<0.0001)USA 2007–2013 – [99] Hospitalisation costs: total Total cost of hospitalisations for adults with bronchiectasis 2004–2015: €448 948 829
2015 only: €48 606 911Spain 2004–2015 – [105] Mean hospitalisation cost per patient over a 1-year period (adults) €4666 Spain 2014–2015 – [40] Overall: €1215
COPD-related bronchiectasis: €2725
>2 exacerbations in study year: €3011
Severe bronchiectasisc: €3784Spain 2013 – [80] €1874 USA 2013 – [106] Mean cost of hospitalisation per patient over a 3-year period €6504
(For comparison purposes, this equates to ∼€2168 per year)Germany 2012–2015 Significantly higher cost of hospitalisation compared with matched controlsa (€4184) (p<0.001) [85] Mean hospitalisation cost per patient in the year pre- and post-P. aeruginosa diagnosis (adults and children) Pre-diagnosis: €15 379
Post-diagnosis: €27 612
(Significant increase in cost; p=0.0004)USA 2007–2013 – [99] Hospitalisation costs: per hospitalisation Cost per hospitalisation (adults) €2941 New Zealand 2015 – [95] €1070 China 2020 – [107] Cost per hospitalisation (children) €18 242 Australia 2020 – [108] Daily cost of hospitalisation (children) €1508 Australia 2020 – [108] Hospitalisation costs: in-hospital treatments Mean total cost of treatments administered in the hospital ward per patient over a 1-year period (adults) Overall: €432
Intravenous antibiotics: €234
Inhalersd: €59Spain 2014–2015 – [40] ED visit costs: overall Mean ED visit cost per patient over a 1-year period (adults) €432 Spain 2014–2015 – [40] Overall: €73
COPD-related bronchiectasis: €125
>2 exacerbations in study year: €165
Severe bronchiectasisc: €188Spain 2013 – [80] Mean ED visit cost per patient in the year pre- and post-P. aeruginosa diagnosis (adults and children) Pre-diagnosis: €214
Post-diagnosis: €310
(Significant increase in cost; p<0.001)USA 2007–2013 – [99] ED visit costs: treatments administered in the ED Mean total cost of treatments administered in the ED per patient over a 1-year period (adults) Overall: €41
Intravenous antibiotics: €17
Inhalers: €11Spain 2014–2015 – [40] Outpatient visit costs Mean cost of outpatient care per patient over 1-year period (adults) €1965 USA 2013 – [106] Mean outpatient diagnostic and visiting costs per patient over a 3-year period €2984
(For comparison purposes, this equates to ∼€995 per year)Germany 2012–2015 No significant difference compared with matched controlsa (€2793) (p=0.27) [80] Mean physician office visit cost per patient in the year pre- and post-P. aeruginosa diagnosis (adults and children) Pre-diagnosis: €1717
Post-diagnosis: €3076
(Significant increase in cost; p<0.001)USA 2007–2013 – [99] HITH costs Mean HITH cost per patient over a 1-year period (adults) €2576 Spain 2014–2015 – [40] Cost of prescribed treatments Mean cost of outpatient prescribed drugs per patient over a 3-year period Overall: €7695
Anti-obstructive drugs: €1595
Antibiotics: €414
Mucoactive agents: €70
(For comparison purposes, this equates to ∼€2565, €532, €138 and €23 per year, respectively)Germany 2012–2015 No significant difference in overall cost compared with matched controlsa (€6605) (p=0.67)
Significantly higher cost of anti-obstructive drugs (p<0.001), antibiotics (p<0.001) and mucoactive agents (p=0.001) compared with matched controlsa[85] Mean cost of treatments per patient over a 1-year period (adults) Inhaled antibiotics: €2042
Inhalers (LABA, ICS, anticholinergics): €759
Oral antibiotics: €151
Home oxygen therapy: €111Spain 2013 – [80] Prescription medication (outpatient): €382 USA 2013 – [106] Mean cost of prescribing antibiotics per patient per year (adults) €117 South Korea 2012–2017 – [104] Mean pharmacy cost per patient in the year pre- and post-P. aeruginosa diagnosis (adults and children) Pre-diagnosis: €3276
Post-diagnosis: €6616
(Significant increase in cost; p<0.001)USA 2007–2013 – [99] Other medical costs Mean physiotherapy cost per patient over a 1-year period (adults) Overall: €41
>2 exacerbations in study year: €56
COPD-related bronchiectasis: €59
Severe bronchiectasisc: €100Spain 2013 – [80] Mean cost of outpatient remedies (e.g. physiotherapy and breathing/drainage techniques) per patient over a 3-year period Overall: €389
(For comparison purposes, this equates to ∼€130 per year)Germany 2012–2015 Significantly higher cost of outpatient remedies compared with matched controlsa (€240) (p=0.02)a [85] Mean cost of outpatient medication aids (e.g. nebulisers and respiration therapy equipment) per patient over a 3-year period Overall: €1086
(For comparison purposes, this equates to ∼€362 per year)Germany 2012–2015 Significantly higher cost of outpatient medical aids compared with matched controlsa (€394) (p<0.001)a [85] Mean convalescence costs (admission to convalescence centre) per patient over a 1-year period (adults) Overall: €52
COPD-related bronchiectasis: €126
>2 exacerbations in study year: €127
Severe bronchiectasisc: €261Spain 2013 – [80] Indirect impacts and costs Sick leave, sick pay and income lost due to absenteeism Mean days of sick leave and mean cost of sick pay per patient over a 1-year period (adults) Sick leave days: 13.4
Sick leave pay: €778Spain 2014–2015 – [40] Mean days of sick leave and mean cost of sick pay per patient over a 3-year period Sick leave days: 40.5
Sick leave paye: €22
(For comparison purposes, this equates to ∼13.5 days and ∼€7 per year, respectively)Germany 2012–2015 No significant difference in sick leave days or sick leave pay compared with matched controlsa (45.7 days; €22) (p=0.18; p=0.8)a [85] Mean cost of absenteeism per patient over a 3-year period €4230
(For comparison purposes, this equates to ∼€1410 per year)Germany 2012–2015 – [85] Missed work and lost wages for caregivers of patients with bronchiectasis Median number of carers who missed work (carers of children) Primary carers: 11.6 per 100 child-monthsf
Secondary carers: 3.5 per 100 child-monthsfAustralia and New Zealand 2012–2016 – [93] Median number of workdays missed by carers (carers of children) Primary carers: 3.5 days per child-yearf
Secondary carers: 0.5 days per child-yearfAustralia and New Zealand 2012–2016 – [93] Mean days of sick leave and mean cost of sick pay per carer over a 1-year period (carers of adults) Sick leave days: 6.2
Sick leave pay: €357Spain 2014–2015 – [40] Lost wages or opportunity costs for parents who stayed in hospital with their child per admission €1614 Australia 2020 – [108] Missed school or childcare Median number of children who missed school or childcare 24.9 per 100 child-monthsf Australia and New Zealand 2012–2016 – [93] Median number of days that children missed school or childcare 12 days per child-yearf Australia and New Zealand 2012–2016 – [93] Percentage of children absent from school due to respiratory symptoms in the previous year 46.9% Australia, Alaska and New Zealand 2015–2018 – [109] Blank cells indicate costs for which there was no comparison with matched controls. a: Matched for age, sex and comorbidities. b: Defined as current or previous chronic bronchial infection with P. aeruginosa. c: Defined as a FACED (Forced expiratory volume in 1 s, Age, Chronic Colonisation, Extension, Dyspnoea) score of 5–7. d: Including bronchodilators and ICS. e: Sick pay is paid out in the statutory company health insurance as a substitute wage from Day 43 of the sick leave according to Section 44 of the 5th German Social Code (this does not include the initial 6 weeks full employers pay) [85]. f: Child-years and child-months take into account the number of children in the study as well as the amount of time each child was followed up for. ED: emergency department; HITH: hospital in the home; ICS: inhaled corticosteroids; LABA: long-acting beta agonists; P.: Pseudomonas; TB: tuberculosis.
Supplementary Material
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Supplementary figures and tables ERR-0049-2024.SUPPLEMENT
Supplementary Excel file ERR-0049-2024.SUPPLEMENT
