TY - JOUR
T1 - Costs of management of acute respiratory infections in older adults
T2 - a systematic review and meta-analysis
AU - Zhang, Shanshan
AU - Wahi-Singh, Pia
AU - Wahi-Singh, Bhanu
AU - Chisholm, Alison
AU - Keeling, Polly
AU - Nair, Harish
N1 - Funding Information:
corresponding author) and declare the following activities: HN reports grants from Innovative Medicines Initiative, during the conduct of the study; grants and personal fees from World Health Organisation, grants and personal fees from Bill and Melinda Gates Foundation, grants and personal fees from Sanofi, grants from National Institute of Health Research, outside the submitted work. All other authors declare no competing interests. The authors completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available upon request from the corresponding author). Additional material Online Supplementary Document 1 IHME. GBD Data Visalization. 2017. Available: http://www.healthdata.org/gbd/data-visualizations. Accessed 24th June 2022. 2 Zhang S, Sammon PM, King I, Andrade AL, Toscano CM, Araujo SN, et al. Cost of management of severe pneumonia in young children: systematic analysis. J Glob Health. 2016;6:010408. Medline:27231544 doi:10.7189/jogh.06.010408 3 Nair H, Ramilo O, Eichler I, Pelfrene E, Mejias A, Polack FP, et al. Meeting Report: Harmonization of RSV therapeutics – from design to performance. J Glob Health. 2016;6:010205. 4 IMI. Analysing the infectious disease burden and the use of vaccines to improve healthy years in raging populations. Funding call: IMI-2017-12-05. 2017. Available: http://ec.europa.eu/research/participants/portal/desktop/en/opportunities/h2020/top-ics/imi2-2017-12-05.html. Accessed 24th June 2022. 5 Ginsburg AS, Klugman KP. Vaccination to reduce antimicrobial resistance. Lancet Glob Health. 2017;5:e1176. Med-line:29128252 doi:10.1016/S2214-109X(17)30364-9 6 Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1. Medline:25554246 doi:10.1186/2046-4053-4-1 7 IMF. World Economic Outlook database. 2022. Available: https://www.imf.org/en/Publications/WEO/weo-database/2022/ April. Accessed: 24th June 2022. 8 OECD. OECD statistics. 2022. Available: https://stats.oecd.org/Index.aspx?DataSetCode=SNA_TABLE4 Accessed 24th June 2022. 9 Andabaka T, Nickerson JW, Rojas-Reyes MX, Rueda JD, Bacic Vrca V, Barsic B. Monoclonal antibody for reducing the risk of respiratory syncytial virus infection in children. Cochrane Database Syst Rev. 2013;CD006602. Medline:23633336 10 Peytremann-Bridevaux I, Arditi C, Gex G, Bridevaux PO, Burnand B. Chronic disease management programmes for adults with asthma. Cochrane Database Syst Rev. 2015;Cd007988. Medline:26014500 doi:10.1002/14651858.CD007988.pub2 11 Vollenweider DJ, Frei A, Steurer-Stey CA, Garcia-Aymerich J, Puhan MA. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2018;10:CD010257. Medline:30371937 doi:10.1002/14651858.CD010257. pub2 12 Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care pro-grammes: Oxford University Press; 2015. 13 Baldo V, Cocchio S, Baldovin T, Buja A, Furlan P, Bertoncello C, et al. A population-based study on the impact of hospitaliza-tion for pneumonia in different age groups. BMC Infect Dis. 2014;14:485. Medline:25192701 doi:10.1186/1471-2334-14-485 14 Bartolomé M, Almirall J, Morera J, Pera G, Ortun V, Bassa J, et al. A population-based study of the costs of care for communi-ty-acquired pneumonia. Eur Respir J. 2004;23:610-6. Medline:15083763 doi:10.1183/09031936.04.00076704 15 Monge V, San-Martin VM, Gonzalez A. The burden of community-acquired pneumonia in Spain. Eur J Public Health. 2001;11:362-4. Medline:11766474 doi:10.1093/eurpub/11.4.362 16 Costa N, Hoogendijk EO, Mounie M, Bourrel R, Rolland Y, Vellas B, et al. Additional Cost Because of Pneumonia in Nursing Home Residents: Results From the Incidence of Pneumonia and Related Consequences in Nursing Home Resident Study. J Am Med Dir Assoc. 2017;18:453.e7-e12. Medline:28433120 doi:10.1016/j.jamda.2017.01.021 17 Personne V, Chevalier J, Buffel du Vaure C, Partouche H, Gilberg S, de Pouvourville G. CAPECO: Cost evaluation of com-munity acquired pneumonia managed in primary care. Vaccine. 2016;34:2275-80. Medline:26979138 doi:10.1016/j.vac-cine.2016.03.013 18 Dupuis C, Sabra A, Patrier J, Chaize G, Saighi A, Feger Cl, et al. Burden of pneumococcal pneumonia requiring ICU admis-sion in France: 1-year prognosis, resources use, and costs. Crit Care. 2021;25:24. Medline:33423691 doi:10.1186/s13054-020-03442-z 19 Rozenbaum MH, Mangen MJ, Huijts SM, van der Werf TS, Postma MJ. Incidence, direct costs and duration of hospitalization of patients hospitalized with community acquired pneumonia: A nationwide retrospective claims database analysis. Vaccine. 2015;33:3193-9. Medline:25981488 doi:10.1016/j.vaccine.2015.05.001 20 Vissink CE, Huijts SM, de Wit GA, Bonten MJ, Mangen MJ. Hospitalization costs for community-acquired pneumonia in Dutch elderly: an observational study. BMC Infect Dis. 2016;16:466. Medline:27589847 doi:10.1186/s12879-016-1783-9 21 Tichopad A, Roberts C, Gembula I, Hajek P, Skoczynska A, Hryniewicz W, et al. Clinical and economic burden of communi-ty-acquired pneumonia among adults in the Czech Republic, Hungary, Poland and Slovakia. PLoS One. 2013;8:e71375. Med-line:23940743 doi:10.1371/journal.pone.0071375
Funding Information:
Funding: RESCEU has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 116019. This Joint Undertaking receives support from the European Union’s Horizon 2020 research and innovation programme and EFPIA.
Publisher Copyright:
© 2022,Journal of Global Health. All Rights Reserved.
PY - 2022/11/8
Y1 - 2022/11/8
N2 - BACKGROUND: Acute respiratory infections (ARIs) accounted for an estimated 3.9 million deaths worldwide in 2015, of which 56% occurred in adults aged 60 years or older. We aimed to identify the cost of ARI management in older adults (≥50 years) in order to develop an evidence base to assist decision-making for resource allocation and inform clinical practice.METHODS: We searched 8 electronic databases including Global Health, Medline and EMBASE for studies published between January 1, 2000 and December 31, 2021. Total management costs per patient per ARI episode were extracted and meta-analysis was conducted by World Health Organization (WHO) region and World Bank income level. All costs were converted and inflated to Euros (€) (2021 average exchange rate). The quality of included studies and the potential risk of bias were evaluated.RESULTS: A total of 42 publications were identified for inclusion, reporting cost data for 8 082 752 ARI episodes in older adults across 20 countries from 2001 to 2021. The majority (86%) of studies involved high-income countries based in Europe, North America and Western Pacific. The mean cost per episode was €17 803.9 for inpatient management and €128.9 for outpatient management. Compared with costs reported for patients aged <65 years, inpatient costs were €154.1, €7 018.8 and €8 295.6 higher for patients aged 65-74 years, 75-84 years and over 85 years. ARI management of at-risk patients with comorbid conditions and patients requiring higher level of care, incurred substantially higher costs for hospitalization: €735.9 and €1317.3 respectively.CONCLUSIONS: ARIs impose a substantial economic burden on health systems, governments, patients and societies. This study identified high ARI management costs in older adults, reinforcing calls for investment by global health players to quantify and address the scale of the challenge. There are large gaps in data availability from low-income countries, especially from South East Asia and Africa regions.
AB - BACKGROUND: Acute respiratory infections (ARIs) accounted for an estimated 3.9 million deaths worldwide in 2015, of which 56% occurred in adults aged 60 years or older. We aimed to identify the cost of ARI management in older adults (≥50 years) in order to develop an evidence base to assist decision-making for resource allocation and inform clinical practice.METHODS: We searched 8 electronic databases including Global Health, Medline and EMBASE for studies published between January 1, 2000 and December 31, 2021. Total management costs per patient per ARI episode were extracted and meta-analysis was conducted by World Health Organization (WHO) region and World Bank income level. All costs were converted and inflated to Euros (€) (2021 average exchange rate). The quality of included studies and the potential risk of bias were evaluated.RESULTS: A total of 42 publications were identified for inclusion, reporting cost data for 8 082 752 ARI episodes in older adults across 20 countries from 2001 to 2021. The majority (86%) of studies involved high-income countries based in Europe, North America and Western Pacific. The mean cost per episode was €17 803.9 for inpatient management and €128.9 for outpatient management. Compared with costs reported for patients aged <65 years, inpatient costs were €154.1, €7 018.8 and €8 295.6 higher for patients aged 65-74 years, 75-84 years and over 85 years. ARI management of at-risk patients with comorbid conditions and patients requiring higher level of care, incurred substantially higher costs for hospitalization: €735.9 and €1317.3 respectively.CONCLUSIONS: ARIs impose a substantial economic burden on health systems, governments, patients and societies. This study identified high ARI management costs in older adults, reinforcing calls for investment by global health players to quantify and address the scale of the challenge. There are large gaps in data availability from low-income countries, especially from South East Asia and Africa regions.
KW - Aged
KW - Europe
KW - Global Health
KW - Hospitalization
KW - Humans
KW - Poverty
KW - Respiratory Tract Infections/epidemiology
U2 - 10.7189/jogh.12.04096
DO - 10.7189/jogh.12.04096
M3 - Article
C2 - 36342670
SN - 2047-2978
VL - 12
JO - Journal of Global Health
JF - Journal of Global Health
M1 - 04096
ER -