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. 2022 Feb;11(1):249-262.
doi: 10.1007/s40121-021-00546-z. Epub 2021 Nov 17.

Long-Term Mortality and State Financial Support in Invasive Meningococcal Disease-Real-World Data Analysis Using the French National Claims Database (SNIIRAM)

Jing Shen  1 , Stéphane Bouée  2 , Emmanuel Aris  1 , Corinne Emery  2 , Ekkehard C Beck  3
Affiliations

Long-Term Mortality and State Financial Support in Invasive Meningococcal Disease-Real-World Data Analysis Using the French National Claims Database (SNIIRAM)

Jing Shen et al. Infect Dis Ther. 2022 Feb.

Erratum in

Abstract

Objectives: Invasive meningococcal disease (IMD) is an uncommon disease known for its acute phase mortality and long-term sequelae. The objective was to assess the impact of IMD on post-discharge mortality risk and dependence on the French state for financial aid.

Methods: A 6-year retrospective analysis in the national insurance database (SNIIRAM) assessed mortality in IMD cases (both during acute phase and post-discharge) and matched controls as well as benefit claims (i.e., for salary loss compensation [SLC], long-term sickness [ALD] and complementary health insurance [CMUc]). Observed survival data were extrapolated to estimate lifetime life expectancy following IMD.

Results: Between 2012 and 2017, 3532 incident IMD cases were hospitalised in France (peak in < 2 years and 15-24 year olds), of which 23.3% developed sequelae. With an average follow-up of 2.8 years, 12.9% of cases vs. 3.2% of controls died (p < 0.0001), with significantly more cases than controls dying both during the acute phase and post-discharge. Around a third of these deaths occurred post-discharge. Extrapolation to lifetime life expectancy estimated that having IMD at any age significantly reduces life expectancy in survivors of the acute disease phase, e.g., by around 16 years for cases aged 0-50 years. IMD cases in France were significantly more likely to receive state-funded SLC (relative risk [RR] 3.9, 95% confidence interval [95% CI] 2.3-6.4) and ALD benefits (RR 1.85, 95% CI 1.71-2.00).

Conclusions: IMD has a significant impact on mortality post-discharge, expected to persist over a lifetime. In addition to long-term sequelae, the financial burden extends beyond the healthcare sector. These results highlight the importance of IMD prevention (e.g., vaccination).

Keywords: Financial aid; France; Invasive meningococcal disease; Long-term mortality.

Plain language summary

Invasive meningococcal disease (IMD) is an uncommon disease mainly affecting children, with severe consequences such as a risk of dying within hours of symptoms and a risk of developing long-term conditions affecting health, learning and ability to work. Little is known of the risk of dying in survivors after discharge from hospital or of survivors’ financial support needs. The French national insurance claims database (SNIIRAM) was reviewed for data on IMD patients hospitalised between 2012 and 2017 and matched controls without IMD. Data, available following IMD hospitalisation for an average of around 3 years, were extrapolated to estimate the lifelong impact of the disease. Among 3532 hospitalised IMD cases, the study found that nearly 13% died, of which a third of deaths occurred post-discharge. The cases who survived the acute disease phase were also more likely to require government funds because of loss of salary or to cover long-term healthcare costs. In addition to the well-known acute phase burden of IMD, this study has shown that there is a long-term effect on risk of dying and on need for government support. This demonstrates the importance of prevention, for example, by vaccination.

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Figures

Fig. 1
Fig. 1
IMD cases (all serogroups) over the study period by age group. N number
Fig. 2
Fig. 2
Distribution of IMD cases and deaths (%) (acute phase + post-discharge) aged < 25 years
Fig. 3
Fig. 3
Survival curves for IMD cases and controls a from IMD episode in total population, b post-discharge in IMD survivors
Fig. 4
Fig. 4
Hazard rates (HR) for post-discharge death in IMD survivors vs. controls, by age group at infection. HR hazard rate, IMD invasive meningococcal disease
Fig. 5
Fig. 5
Extrapolated lifetime survival curves and life expectancy by age at IMD
Fig. 6
Fig. 6
Extrapolated lifetime life expectancy by age at IMD. IMD invasive meningococcal disease
See this image and copyright information in PMC

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