Pneumologie 2016; 70 - A61
DOI: 10.1055/s-0036-1592288

Healthcare cost and utilization before and after diagnosis of pseudomonas aeruginosa among patients with non-cystic fibrosis bronchiectasis in the US

C Blanchette 1, J Noone 1, G Stone 2, E Zacherle 1, MC Runken 2, R Howden 1, D Mapel 3
  • 1University of North Carolina at Charlotte
  • 2Grifols
  • 3Lovelace Clinic Foundation

Objectives:

Non-cystic fibrosis bronchiectasis (NCFBE) is a rare, chronic lung disease characterized by bronchial inflammation and permanent airway dilation. Chronic infections with Pseudomonas aeruginosa (PA) have been linked to higher morbidity and mortality in NCFBE patients. We assessed healthcare cost and utilization in the year before and after PA diagnosis among US commercially-insured NCFBE patients.

Methods:

Using data from 2007 – 2013 PharMetrics Plus administrative claims, we included patients with > 2 claims for bronchiectasis (ICD-9-CM: 494.xx) and > 1 claim for PA (482.1 or 041.7); then excluded those with a claim for cystic fibrosis (277.xx). Patients were indexed at first claim for PA and were required to have > 12 months before and after the index PA claim for assessment of healthcare cost and resource utilization. The mean difference in utilization and costs were assessed using paired t-test for statistical significance.

Results:

Of 23,740 patients with NCFBE, 716 had PA. Patients with PA were mostly over age 50 (88.8%) and female (60.5%), had a high rate of cardiac arrhythmias (28.6%) and uncontrolled hypertension (49.6%). Total healthcare costs per patient in the year prior to PA diagnosis was $36,213 on average compared to $67,764 in the year following, for an increase of 87% or $31,551 (p < 0.0001). Hospital cost represented the largest proportion of total healthcare cost after PA diagnosis (54%) and was associated with an 80% increase or $16,243 (p = 0.0004), representing an increase of 4 hospitalizations per patient (p < 0.0001).

Conclusions:

NCFBE patients with evidence of PA incur substantially greater healthcare costs and utilization after diagnosis of PA. While these patients may have had PA prior to diagnosis, they appear to consume greater healthcare services post-diagnosis. Future research should explore methods of earlier identification of NCFBE patients with PA, as this may lead to a reduction in US healthcare costs.

Funding Source:

Grifols, RTP, NC