Epidemiology and economic burden of bronchiectasis requiring hospitalisation in Singapore

Abstract

Background and objectiveLittle is known about the epidemiology and cost of bronchiectasis in Asia. This study describes the disease burden of bronchiectasis in Singapore.MethodsA nationwide administrative dataset was used to identify hospitalisations with bronchiectasis as a diagnosis. Population statistics and medical encounter data were used to estimate the incidence, mortality, prevalence and direct medical costs associated with hospitalisation-requiring bronchiectasis.ResultsThere were 420 incident hospitalised bronchiectasis patients in 2017, giving an incidence rate of 10.6/100 000. Age-standardised incidence declined on average by 2.7% per year between 2007 and 2017. Incidence rates increased strongly with age in both men and women. Tuberculosis was a secondary diagnosis in 37.5% of incident hospitalisations in 2007, but has declined sharply since then. Patient survival was considerably lower in both men (5-year Relative Survival Ratios (RSR) of 0.63 (95% CI, 0.59 to 0.66)) and women ((5-year RSR of 0.75 (95% CI, 0.72 to 0.78)). The point prevalence of bronchiectasis was 147.1/100,000 in 2017, and increased sharply with age, with more than 1% of people aged 75 years and older having bronchiectasis. Total first-year costs among incident bronchiectasis patients in 2016 varied widely, with an average of $7331 (standard deviation of $8863). About 10% of the patients admitted in 2016 had total first-year costs of more than $14 380.ConclusionBronchiectasis is common and imposes a substantial burden on health care costs and survival rates of patients in Singapore.

Bronchiectasis: moving from an orphan disease to an unpleasant socioeconomic burden

“…It is interesting to note that, as found by P hua et al [ 14 ], in other studies most health expenditures related to bronchiectasis were linked to hospitalisations [ 16 , 17 ]. Despite the existence of variability in the rate of hospitalisation related to bronchiectasis between countries, the impact of this condition on health systems is unquestionable.…”

“…This is a relevant topic since not every finding can be promptly extrapolated to the reality of other populations. In this study by P hua et al [ 14 ], they found a decline in the age-standardised incidence of hospitalised bronchiectasis over time. One of the reasons attributed by the authors for this finding was the significant reduction in tuberculosis cases in Singapore in recent years [ 14 ], since Mycobacterium tuberculosis infection is a well-recognised cause of bronchiectasis.…”

“…In this study by P hua et al [ 14 ], they found a decline in the age-standardised incidence of hospitalised bronchiectasis over time. One of the reasons attributed by the authors for this finding was the significant reduction in tuberculosis cases in Singapore in recent years [ 14 ], since Mycobacterium tuberculosis infection is a well-recognised cause of bronchiectasis. Unfortunately, this is still not reality for several South American, African and Asian countries [ 22 ].…”

“…In this issue of ERJ Open Research , P hua et al [ 14 ] have comprehensively evaluated the prevalence and incidence of bronchiectasis requiring hospitalisation in Singapore, as well as the associated healthcare utilisation and costs. They found high age-standardised incidence of hospitalised bronchiectasis that declined from 13.9 per 100 000 persons in 2007 to 10.6 per 100 000 persons in 2017 (an average decline of 2.7% per year).…”

“…The majority of this cost was due to hospitalisation, representing 55.8% of direct medical costs. It is interesting to note that there has been an average annual increase of 5.0% for inpatient cost per patient (USD 4032 in 2007 versus USD 6563 in 2017), which reflects the increasing complexity of treating these patients [ 14 ]. These data are in agreement with other recent publications that have also demonstrated the great economic burden related to bronchiectasis.…”