The economic burden of bronchiectasis - known and unknown: a systematic review

Abstract

Background: The increasing prevalence and recognition of bronchiectasis in clinical practice necessitates a better understanding of the economic disease burden to improve the management and achieve better clinical and economic outcomes. This study aimed to assess the economic burden of bronchiectasis based on a review of published literature.

Methods: A systematic literature review was conducted using MEDLINE, Embase, EconLit and Cochrane databases to identify publications (1 January 2001 to 31 December 2016) on the economic burden of bronchiectasis in adults.

Results: A total of 26 publications were identified that reported resource use and costs associated with management of bronchiectasis. Two US studies reported annual incremental costs of bronchiectasis versus matched controls of US$5681 and US$2319 per patient. Twenty-four studies reported on hospitalization rates or duration of hospitalization for patients with bronchiectasis. Mean annual hospitalization rates per patient, reported in six studies, ranged from 0.3-1.3, while mean annual age-adjusted hospitalization rates, reported in four studies, ranged from 1.8-25.7 per 100,000 population. The average duration of hospitalization, reported in 12 studies, ranged from 2 to 17 days. Eight publications reported management costs of bronchiectasis. Total annual management costs of €3515 and €4672 per patient were reported in two Spanish studies. Two US studies reported total costs of approximately US$26,000 in patients without exacerbations, increasing to US$36,00-37,000 in patients with exacerbations. Similarly, a Spanish study reported higher total annual costs for patients with > 2 exacerbations per year (€7520) compared with those without exacerbations (€3892). P. aeruginosa infection increased management costs by US$31,551 to US$56,499, as reported in two US studies, with hospitalization being the main cost driver.

Conclusions: The current literature suggests that the economic burden of bronchiectasis in society is significant. Hospitalization costs are the major driver behind these costs, especially in patients with frequent exacerbations. However, the true economic burden of bronchiectasis is likely to be underestimated because most studies were retrospective, used ICD-9-CM coding to identify patients, and often ignored outpatient burden and cost. We present a conceptual framework to facilitate a more comprehensive assessment of the true burden of bronchiectasis for individuals, healthcare systems and society.

Keywords: Bronchiectasis; Burden of illness; Costs; Economic burden; Hospitalization; Resource use.

Fig. 1

PRISMA flow diagram. Reasons for exclusion of articles from the initial search from inclusion in the report (n = 12): relevant data not reported or very limited (n = 4), patient population not specifically bronchiectasis (n = 5), and duplicate (full paper identified in the update search, n = 3). Reasons for exclusion of articles from the updated search: relevant data not reported or very limited (n = 5). The updated search identified economic and HRQoL studies but was only screened to identify economic articles

Fig. 2

Distribution of costs in patients with bronchiectasis according to disease severity. Analysis of data from six hospitals (n = 456). Severity was assessed according to the FACED score: mild, 0–2 (i.e. low mortality risk); moderate, 3–4; and severe, 5–7 (i.e. high mortality risk) Inhalers included long-acting beta-agonists, inhaled corticoids and short- or long-acting anticholinergics. Adapted from de la Rosa et al., 2016 [19]

Fig. 3

Conceptual framework for assessment of the economic burden of bronchiectasis. BMI body mass index, ER emergency room, FEV forced expiratory volume, HRCT high-resolution computed tomography, HRQoL health-related quality of life, ICU intensive care unit, IV intravenous, NIV non-invasive ventilation