The costs of invasive pneumococcal disease in older children, adults and the elderly A preliminary analysis

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1 5th Regional Pneumococcal Symposium São Paulo, Brazil 5 6 March 2013 The costs of invasive pneumococcal disease in older children, adults and the elderly A preliminary analysis Dagna Constenla, PhD International Vaccine Access Center Johns Hopkins University

2 Disclaimer: The findings, interpretations, and conclusions expressed in this presentation are entirely those of the authors and should not be attributed in any manner to the JHU s IVAC, to its affiliated organizations or the countries they represent.

3 Background Objectives Methods Preliminary findings Study limitations Overall conclusions Outline of the session

4 Costs of IPD are multi-dimensional Direct costs of treatment Background Non-medical costs (e.g. travel) Productivity loss (e.g. lost work time) Costs associated with management of IPD are under-reported and underestimated Studies estimating costs of IPD are limited Financial rather than economic costs Not generalizable to other populations Costs are needed to understand the true economic burden of pneumococcal disease

5 Study objectives To estimate the economic burden of IPD o Average cost per hospitalized patient with bacterial pneumonia and meningitis in selected countries o Average cost per hospitalized patient with bacterial pneumonia and meningitis in the region o Impact of IPD on the GDP per capita

6 Study objectives To estimate the economic burden of IPD o Average cost per hospitalized patient with bacterial pneumonia and meningitis in selected countries o Average cost per hospitalized patient with bacterial pneumonia and meningitis in the region o Impact of IPD on the GDP per capita

7 Ingredient method of cost estimation applied retrospectively, where estimates of each type of event are combined with information on the costs associated with the event Perspective: health care Overall approach Study duration: 4 months to collect data Resource used data from treatment guidelines, physician surveys

8 Physician surveys Specific questions about the diagnosis and treatment of bacteremic pneumonia and meningitis in three age groups: 5-17 year olds, year olds and 65+ year olds Surveys originally developed in English and translated into Spanish o First set of questions on the diagnosis and treatment of pneumonia and meningitis in the acute phase of the illness o Second set on the diagnosis and treatment of pneumonia and meningitis-related complications and sequelae Information gathered from surveys fairly consistent with the national treatment guidelines

9 Physicians interviewed Argentina Brazil Chile Colombia Uruguay Total Pneumonia 5-17 years years 5 11 * years 5 5 * Meningitis 5-17 years years 2 9 * years * * * * * - Total * National treatment guidelines, published literature

10 Health care costs Excel-based model to calculate the costs associated with bacteremic pneumonia and meningitis across age groups and countries Unit cost data from finance departments of local hospitals and national administrative data Cost per stay in the hospital: per diem rate x LOS Cost per tests and procedures: number of each test and procedure x frequency x unit cost Cost per medications: daily dosage x duration x frequency x unit cost

11 Healthcare costs * of IPD in selected countries Argentina Brazil Chile Colombia Uruguay Pneumonia 5-17 years $2,198 $993 $3,132 $2,037 $1, years $2,020 $1,274 $3,247 $2,691 $1, years $2,875 $1,746 $3,535 $3,154 $2,279 Meningitis 5-17 years $2,133 $1,917 $3,708 $2,987 $2, years $2,100 $2,133 $3,911 $3,230 $2, years $2,933 $2,759 $4,490 $3,269 $2,465 * Cost per case, US$, 2012

12 Healthcare costs * of IPD in selected countries Argentina Brazil Chile Colombia Uruguay Pneumonia 5-17 years $2,198 $993 $3,132 $2,037 $1, years $2,020 $1,274 $3,247 $2,691 $1, years $2,875 $1,746 $3,535 $3,154 $2,279 Meningitis 5-17 years $2,133 $1,917 $3,708 $2,987 $2, years $2,100 $2,133 $3,911 $3,230 $2, years $2,933 $2,759 $4,490 $3,269 $2,465 * Cost per case, US$, 2012

13 Healthcare costs * of IPD in selected countries Argentina Brazil Chile Colombia Uruguay Pneumonia 5-17 years $2,198 $993 $3,132 $2,037 $1, years $2,020 $1,274 $3,247 $2,691 $1, years $2,875 $1,746 $3,535 $3,154 $2,279 Meningitis 5-17 years $2,133 $1,917 $3,708 $2,987 $2, years $2,100 $2,133 $3,911 $3,230 $2, years $2,933 $2,759 $4,490 $3,269 $2,465 * Cost per case, US$, 2012

14 Healthcare costs * of IPD in selected countries Argentina Brazil Chile Colombia Uruguay Pneumonia 5-17 years $2,198 $993 $3,132 $2,037 $1, years $2,020 $1,274 $3,247 $2,691 $1, years $2,875 $1,746 $3,535 $3,154 $2,279 Meningitis 5-17 years $2,133 $1,917 $3,708 $2,987 $2, years $2,100 $2,133 $3,911 $3,230 $2, years $2,933 $2,759 $4,490 $3,269 $2,465 * Cost per case, US$, 2012

15 Study objectives To estimate the economic burden of IPD o Average cost per hospitalized patient with bacterial pneumonia and meningitis in selected countries o Average cost per hospitalized patient with bacterial pneumonia and meningitis in the region o Impact of IPD on the GDP per capita

16 Overall approach Estimates of occurrence of IPD from the Novaes et al (2011) paper, which included hospitalization rates for IPD in Brazil Total 5 year old and above population projected by UN considered to estimate IPD cases by age Values based on a regional estimate using population weighted average Direct non-medical costs borne by families and loss of productivity not included

17 Healthcare costs * of IPD in the region Age Pneumococcal pneumonia # Pneumococcal meningitis # 5-17 years $8.2 m (n = 4,159) $8.5 m (n = 3,527) years $13.5 m (n = 6,093) $9.6 m (n = 3,759) 65+ years $14.1 m (n = 5,196) $0.939 m (n = 294) * US$, 2012 (health care perspective) # Cases estimated for the LAC region based on Novaes et al paper (2011)

18 Healthcare costs * of IPD in the region Age Pneumococcal pneumonia # Pneumococcal meningitis # 5-17 years $8.2 m (n = 4,159) $8.5 m (n = 3,527) years $13.5 m (n = 6,093) $9.6 m (n = 3,759) 65+ years $14.1 m (n = 5,196) $0.939 m (n = 294) * US$, 2012 (health care perspective) # Cases estimated for the LAC region based on Novaes et al paper (2011)

19 Comparison of health care costs Aim: To provide further contextual insight into costs associated with IPD WHO-CHOICE estimates versus physician survey estimates o Cost-generating events based on WHO-CHOosing Interventions that are Cost Effective (WHO-CHOICE) o Provides estimates of per diem cost of hospitals, outpatient visits, and health center visits for 14 epidemiological categories based on geographical region and mortality stratum

20 Pneumonia Comparison of healthcare costs WHO-CHOICE data Physician interviews * 5-17 years $1,388 $1, years $1,845 $2, years $2,123 $2,518 Meningitis 5-17 years $1,969 $2, years $2,023 $2, years $2,223 $2,995 * Values are based on a regional estimate using population weighted average of cost per event (US$, 2012).

21 Pneumonia Comparison of healthcare costs WHO-CHOICE data Physician interviews * 5-17 years $1,388 $1, years $1,845 $2, years $2,123 $2,518 Meningitis 5-17 years $1,969 $2, years $2,023 $2, years $2,223 $2,995 * Values are based on a regional estimate using population weighted average of cost per event (US$, 2012).

22 Pneumonia Comparison of healthcare costs WHO-CHOICE data Physician interviews * 5-17 years $1,388 $1, years $1,845 $2, years $2,123 $2,518 Meningitis 5-17 years $1,969 $2, years $2,023 $2, years $2,223 $2,995 * Values are based on a regional estimate using population weighted average of cost per event (US$, 2012).

23 Pneumonia Comparison of healthcare costs WHO-CHOICE data Physician interviews * 5-17 years $1,388 $1, years $1,845 $2, years $2,123 $2,518 Meningitis 5-17 years $1,969 $2, years $2,023 $2, years $2,223 $2,995 * Values are based on a regional estimate using population weighted average of cost per event (US$, 2012).

24 Study objectives To estimate the economic burden of IPD o Average cost per hospitalized patient with bacterial pneumonia and meningitis in selected countries o Average cost per hospitalized patient with bacterial pneumonia and meningitis in the region o Impact of IPD on the GDP per capita * * GDP defined as the market value of all final goods and services produced within a country in a given period

25 Overall approach All LAC countries were considered in the analysis Epidemiological estimates based on Novaes 2011 paper Population-weighted average medical and costs borne by families combined with incidence estimates to assess impact of disease on GDP Future loss productivity considered

26 Impact of IPD on GDP per capita For 2011, total health expenditures of IPD in the LAC region was estimated at $622 million The GDP in LAC was estimated at $5.6 billion in 2011 Based on these estimates, health care spending for IPD as a % of GDP was estimated at 0.01%, compared to the reported 10% spent on health care overall Source: World Bank, 2011

27 Summary of findings IPD incurs considerable costs to health care systems in studied countries generating up to US$4,490 per case Healthcare costs of IPD ranged from US$0.94 million to 14.1 million, with higher costs incurred by the elderly due to higher level of resources used for treating the elderly Spending on IPD as a percentage of GDP for those above 5 years of age was estimated at 0.01%

28 So what? Costs vary by country, with different practice patterns, so.we have to account for differences in the design and conduct of these studies Meningitis is consistently the most costly per case, but the most infrequent disease syndrome, so focus data collection for future costing on getting these costs as accurate as possible Pneumonia is less costly, but more frequent, so target efforts on getting those costs accurately assessed More costs incurred by the elderly due to higher level of resources used for treating the elderly - focus on getting those costs accurately assessed

29 Study limitations Use of expert opinion, with potential bias Cost of treating complications and/or sequelae not included Costs borne by families in less formal settings or in the private sector not included Short study duration Focus on bacterial pneumonia and meningitis only Disease costs in high risk children not considered Estimates used are exactly that - estimates

30 Acknowledgments The Albert B. Sabin Vaccine Institute Pan-American Health Organization (PAHO) Centers for Disease Control and Prevention (CDC) Epidemiology team Economic Team Local physicians and experts