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 EUR18634.57 (95% CI EUR15891.02-23 871.12), 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.