Economic Burden of Non-Cystic Fibrosis Bronchiectasis in the First Year after Diagnosis from A US Health Plan Perspective

Joish, Vijay N.; Spilsbury-Cantalupo, M.; Operschall, Elisabeth; Luong, Ba; Boklage, Susan

doi:10.1007/s40258-013-0027-z

Cited by 70 publications

(55 citation statements)

References 13 publications

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“…Despite this, bronchiectasis is associated with substantial socioeconomic cost due to the frequent use of primary and secondary health-care resources. An US epidemiological study of bronchiectasis-associated hospitalizations from 1993 to 2006 demonstrated an average annual hospitalization rate of 16.5/100 000 population with a significant annual increase of 2.4% in men and 3% in women (Seitz et al, 2010), with the cost of managing bronchiectasis appearing to be rising (Joish et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Predominant pathogen competition and core microbiota divergence in chronic airway infection

2014

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Chronic bacterial lung infections associated with non-cystic fibrosis bronchiectasis represent a substantial and growing health-care burden. Where Pseudomonas aeruginosa is the numerically dominant species within these infections, prognosis is significantly worse. However, in many individuals, Haemophilus influenzae predominates, a scenario associated with less severe disease. The mechanisms that determine which pathogen is most abundant are not known. We hypothesised that the distribution of H. influenzae and P. aeruginosa would be consistent with strong interspecific competition effects. Further, we hypothesised that where P. aeruginosa is predominant, it is associated with a distinct 'accessory microbiota' that reflects a significant interaction between this pathogen and the wider bacterial community. To test these hypotheses, we analysed 16S rRNA gene pyrosequencing data generated previously from 60 adult bronchiectasis patients, whose airway microbiota was dominated by either P. aeruginosa or H. influenzae. The relative abundances of the two dominant species in their respective groups were not significantly different, and when present in the opposite pathogen group the two species were found to be in very low abundance, if at all. These findings are consistent with strong competition effects, moving towards competitive exclusion. Ordination analysis indicated that the distribution of the core microbiota associated with each pathogen, readjusted after removal of the dominant species, was significantly divergent (analysis of similarity (ANOSIM), R ¼ 0.07, P ¼ 0.019). Taken together, these findings suggest that both interspecific competition and also direct and/or indirect interactions between the predominant species and the wider bacterial community may contribute to the predominance of P. aeruginosa in a subset of bronchiectasis lung infections.

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Section: Introductionmentioning

confidence: 99%

Predominant pathogen competition and core microbiota divergence in chronic airway infection

2014

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“…Additionally, antibiotics may be used as long-term therapy or for acute treatment of exacerbations. Along with the economic burden, the incidence of non-CF bronchiectasis continues to rise in the United States, with annual percentages increasing almost 9% every year from 2000 to 2007 (199,207). Although non-CF bronchiectasis is seen across the whole population, the prevalence appears to be highest in individuals of advanced age and females.…”

Section: Non-cf Bronchiectasismentioning

confidence: 99%

Inhaled Antibiotics for Gram-Negative Respiratory Infections

et al. 2016

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SUMMARYGram-negative organisms comprise a large portion of the pathogens responsible for lower respiratory tract infections, especially those that are nosocomially acquired, and the rate of antibiotic resistance among these organisms continues to rise. Systemically administered antibiotics used to treat these infections often have poor penetration into the lung parenchyma and narrow therapeutic windows between efficacy and toxicity. The use of inhaled antibiotics allows for maximization of target site concentrations and optimization of pharmacokinetic/pharmacodynamic indices while minimizing systemic exposure and toxicity. This review is a comprehensive discussion of formulation and drug delivery aspects,in vitroand microbiological considerations, pharmacokinetics, and clinical outcomes with inhaled antibiotics as they apply to disease states other than cystic fibrosis. In reviewing the literature surrounding the use of inhaled antibiotics, we also highlight the complexities related to this route of administration and the shortcomings in the available evidence. The lack of novel anti-Gram-negative antibiotics in the developmental pipeline will encourage the innovative use of our existing agents, and the inhaled route is one that deserves to be further studied and adopted in the clinical arena.

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“…[4][5][6] The FACED score 7 was recently developed to classify patients' severity with a multidimensional scale, which includes age, degree of dyspnoea, FEV 1 %, presence of CBC by Pseudomonas aeruginosa (PA) and number of lobes affected. The few studies published to date on the costs associated with BE show that these are high, [8][9][10] and possibly greater than those described for chronic obstructive pulmonary disease (COPD). [11][12][13][14] Since most of the direct costs of the BE management can be attributed to exacerbations and baseline treatment, 15,16 it is reasonable to suppose that more severe patients give rise to higher health costs.…”

Section: Introductionmentioning

confidence: 97%

Annual direct medical costs of bronchiectasis treatment

et al. 2016

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Patients with bronchiectasis (BE) present exacerbations that increase with severity of the disease. We aimed to determine the annual cost of BE treatment according to its severity, determined by FACED score, as well as the parameters associated with higher costs. Multicentre historical cohorts study with patients from six hospitals in Spain. The costs arising during the course of a year from maintenance treatment, exacerbations, emergency visits and hospital admissions were analysed. In total, 456 patients were included (56.4% mild BE, 26.8% moderate BE and 16.9% severe BE). The mean cost was €4671.9 per patient, which increased significantly with severity. In mild BE, most of the costs were due to bronchodilators and inhaled steroids; in severe BE, most were due to exacerbations and inhaled antibiotics. Forced expiratory volume in 1 second (FEV 1 %), age, colonization by Pseudomonas aeruginosa and the number of admissions were independently related to higher costs. The highest costs were found in patients with BE associated with chronic obstructive pulmonary disease, with the most exacerbations and with chronic bronchial colonization by Pseudomonas aeruginosa (PA). In conclusion, BE patients gave rise to high annual costs, and these were doubled on each advance in severity on the FACED score. FEV 1 %, age, colonization by PA and the number of admissions were independently related to higher costs.

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Economic Burden of Non-Cystic Fibrosis Bronchiectasis in the First Year after Diagnosis from A US Health Plan Perspective

Abstract: This study found that the cost of managing NCFB in the first year within a commercially enrolled population may be burdensome. Compared with previously published estimates in the literature, the burden of NCFB may be also increasing.

Cited by 70 publications

References 13 publications

Predominant pathogen competition and core microbiota divergence in chronic airway infection

Predominant pathogen competition and core microbiota divergence in chronic airway infection

Inhaled Antibiotics for Gram-Negative Respiratory Infections

Annual direct medical costs of bronchiectasis treatment

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