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: €1055 | South 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: €16 743 | Spain | 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: €4306 | Spain | 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: €48 606 911 | Spain | 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: €3784 | Spain | 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: €59 | Spain | 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: €188 | Spain | 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: €11 | Spain | 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: €111 | Spain | 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: €100 | Spain | 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: €261 | Spain | 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: €778 | Spain | 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-monthsf | Australia 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-yearf | Australia 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: €357 | Spain | 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.