Economic burden of bronchiectasis in Germany.

Estimates of healthcare costs for incident bronchiectasis patients are currently not available for any European country.Out of a sample of 4 859 013 persons covered by German statutory health insurance companies, 231 new bronchiectasis patients were identified in 2012. They were matched with 685 control patients by age, sex and Charlson Comorbidity Index, and followed for 3 years.The total direct expenditure during that period per insured bronchiectasis patient was EUR18 634.57 (95% CI EUR15 891.02-23 871.12), nearly one-third higher (ratio of mean 1.31, 95% CI 1.02-1.68) than for a matched control (p<0.001). Hospitalisation costs contributed to 35% of the total and were >50% higher in the bronchiectasis group (ratio of mean 1.56, 95% CI 1.20-3.01; p<0.001); on average, bronchiectasis patients spent 4.9 (95% CI 2.27-7.43) more days in hospital (p<0.001). Antibiotics expenditures per bronchiectasis outpatient (EUR413.81) were nearly 5 times higher than those for a matched control (ratio of mean 4.85, 95% CI 2.72-8.64). Each bronchiectasis patient had on average 40.5 (95% CI 17.1-43.5) sick-leave days and induced work-loss costs of EUR4230.49 (95% CI EUR2849.58-5611.20). The mortality rate for bronchiectasis and matched non-bronchiectasis patients after 3 years of follow-up was 26.4% and 10.5%, respectively (p<0.001). Mortality in the bronchiectasis group was higher among those who also had chronic obstructive lung disease than in patients with bronchiectasis alone (35.9% and 14.6%, respectively; p<0.001).Although bronchiectasis is considered underdiagnosed, the mortality and associated financial burden in Germany are substantial.

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Copyright ©ERS 2019.

Déclaration de conflit d'intérêts

Conflict of interest: R. Diel reports grants from Bayer Vital, during the conduct of the study; personal fees for advisory board work, consultancy and lectures from Insmed Inc., personal fees for advisory board work and consultancy from Bayer Vital, outside the submitted work. Conflict of interest: J.D. Chalmers reports research grants and personal fees from GSK, Boehringer Ingelheim, Pfizer, Bayer Healthcare, Grifols and Insmed, grants from AstraZeneca, and personal fees for consultancy from Napp and Aradigm Corporation, outside the submitted work; and is Deputy Chief Editor of the European Respiratory Journal. Conflict of interest: K.F. Rabe has nothing to disclose. Conflict of interest: A. Nienhaus has nothing to disclose. Conflict of interest: R. Loddenkemper has nothing to disclose. Conflict of interest: F.C. Ringshausen reports research support, fees for consulting, lecture fees and support of patient educational events from Bayer Healthcare, research support and consultancy and lecture fees from Grifols Germany, research support, fees for consulting, clinical trial participation and lecture fees from Insmed Germany, personal fees for lecturing and consulting from AstraZeneca, travel reimbursement, support of patient educational events and clinical trial participation from Chiesi, support of patient educational events from Abbott, Pfizer, Oxycare, Heinen+Löwenstein, MSD, PARI and APOSAN, travel reimbursement and support of patient educational events from Gilead, lecture fees, research support (IMI/EU), clinical trial participation and support of patient educational events from Novartis, research support and support of patient educational events from InfectoPharm, clinical trial participation for Vertex, Parion, Celtaxsys, Corbus, Zambon and GSK, research support (IMI/EU) from Polyphor, and lecture fees from Boehringer Ingelheim, outside the submitted work.