Adults with bronchiectasis face high costs, health care usage

Key takeaways:

• For adults with bronchiectasis, $82,545 was the highest annual health care cost observed in a systematic review.
• The cost of inpatient hospitalization for these patients ranged from $2,020 to $61,447 per year.

Adults with bronchiectasis had high total annual health care costs, and the cost of hospitalization was a major contributor to this amount, according to findings published in CHEST.

“This review highlights the substantial economic burden of bronchiectasis for patients and health systems, but there was a notable absence of data regarding the impact of bronchiectasis in children, and in economically disadvantaged communities,” Jack M. Roberts, BBiomedSc, PhD candidate at the Australian Centre for Health Services Innovation, and colleagues wrote.

Using five databases, Roberts and colleagues reviewed and assessed 53 studies published between January 2001 and October 2022, including adults (31 studies), children (four studies) or both (15 studies) with bronchiectasis from 15 countries to determine the economic burden and health care resource utilization of the disease.

Notably, patients’ age was not reported in three studies.

Frequently reported countries in the total cohort included the U.S. (16 studies), Europe (11 studies), Australia (nine studies) and the U.K. (seven studies), all of which are high-income countries, researchers wrote.

After closer examination, researchers only evaluated findings from 47 studies because the others did not actually meet inclusion criteria.

Among adults with bronchiectasis, total annual health care costs ranged from $3,579 to $82,545, based on results from 10 studies. Data on inpatient hospitalization costs revealed that these costs are a large part of the total annual costs (16 studies; range, $2,020-$61,447), according to researchers.

Between those with vs. without bronchiectasis, researchers found a difference in annual costs of $8,336 at any time after diagnosis in two studies.

Fifteen studies from the total cohort collected mean annual hospitalization rates of adults with bronchiectasis. The lowest rate was 0.11 per year, whereas the highest rate was 2.9 per year. In terms of hospitalization duration, researchers noted a mean stay of 2.4 days in a U.K. study, as well as a median of 17.4 days in a Tunisia study.

Adults with this disease also often visited a primary care physician (seven studies; range, 1.1-14.4 visits/year) and an outpatient respiratory physician (seven studies; mean range, 0.83-6.8 visits/year) to receive care.

Compared with hospitalization costs, researchers observed a lower range for annual indirect costs due to absence from work (two studies; $1,311-$2,898).

Several variables raised costs in adults based on findings from the included studies: hospitalization rates, hospitalization duration, chronic bronchial infection, exacerbations/exacerbation frequency, pharmaceutic expenses, disease severity, older age and comorbidities.

Among children with bronchiectasis, only one study assessed hospitalization cost ($23,522 per hospitalization), and only one study assessed indirect costs ($2,368/year).

Similar to adults, researchers found that children with this disease visited a primary care physician and an outpatient respiratory physician at least once a year (mean, 1.49 visits/year; 1.9 visits/year).

Bronchiectasis also negatively impacted children’s school attendance, with one study reporting 12.5 missed days/year due to the disease.

Across nine countries, Singapore had the lowest estimated aggregate annual health care costs at $101.6 million, whereas the U.S. had the highest estimated annual cost at $14.68 billion.

The U.K. demonstrated the highest estimated aggregate annual bronchiectasis cost at $1.63 billion, followed by Spain ($1.35 billion), Germany ($740.31 million) and Australia ($17.77 million), according to researchers.

“Priorities for further research include quantifying and managing health care use and costs in resource-constrained settings, and in the context of pediatric bronchiectasis,” Roberts and colleagues wrote. “Given that pediatric bronchiectasis can be potentially reversible, successful early identification and treatment may avert health care resource use into adulthood.”