The economic and health burdens of diseases caused by group A Streptococcus in New Zealand

Cannon, J. R.; Zhung, Jane; Bennett, Julie; Moreland, Nicole J.; Baker, Michael G; Geelhoed, Elizabeth; Fraser, John J.; Carapetis, Jonathan R.; Jack, Susan

doi:10.1016/j.ijid.2020.11.193

Cited by 23 publications

(14 citation statements)

References 27 publications

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“…While the Australian cost was limited to the health care sector perspective for children hospitalised with iGAS, comparison is made with the annual cost of all non-hospitalised GAS pharyngitis disease in children ($284 and $684 million 2019 USD), and with the annual direct healthcare costs in New Zealand associated with all GAS disease across children and adults at $46 million 2019 USD [ 6 ]. In Australia, the true costs may be considerably higher as this estimation draws on a minimum rate, it is expected that some patients would have needed ongoing follow-up care beyond the 6-month follow-up period, and it is exclusive of indirect costs such as parental loss of income associated with caring for the child which is included in the US study [ 6 ]. Based on the US study [ 6 ], the inclusion of indirect costs, such as parental lost work, could potentially double the financial burden of the current iGAS in Australia.…”

Section: Discussionmentioning

confidence: 99%

“…In Australia, the true costs may be considerably higher as this estimation draws on a minimum rate, it is expected that some patients would have needed ongoing follow-up care beyond the 6-month follow-up period, and it is exclusive of indirect costs such as parental loss of income associated with caring for the child which is included in the US study [ 6 ]. Based on the US study [ 6 ], the inclusion of indirect costs, such as parental lost work, could potentially double the financial burden of the current iGAS in Australia. It is currently unknown how long-term iGAS related disabilities, beyond the 6-month follow up period, would impact the cost estimates, or if long term costs would be covered by the public health system, the National Disability Insurance Scheme, or privately through health insurance or out-of-pocket costs.…”

Section: Discussionmentioning

confidence: 99%

“…In the United States, the annual cost associated with all GAS pharyngitis disease in children was estimated between $284 and $684 million 2019 USD (CPI https://www.bls.gov/data/inflation_calculator.htm; $224 and $539 million; 2006 USD), with just over half this sum as direct healthcare costs and the remainder as indirect costs, including lost productivity through parental time off work [ 5 ]. In New Zealand, the annual direct healthcare costs associated with all GAS disease across children and adults was estimated at $46 million 2019 USD (CPI https://www.bls.gov/data/inflation_calculator.htm and purchasing power parities (PPP) https://data.oecd.org/conversion/purchasing-power-parities-ppp.htm#indicator-chart; $30 million; 2015 NZD) [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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The cost of care for children hospitalised with Invasive Group A Streptococcal Disease in Australia

Brusco

Oliver

McMinn

et al. 2021

BMC Health Serv Res

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Background Invasive Group A Streptococcal (iGAS) disease exerts an important burden among Australian children. No Australian hospitalisation cost estimates for treating children with iGAS disease exist, so the financial impact of this condition is unknown. Aim To determine the minimum annual healthcare cost for children (< 18 years) hospitalised with iGAS disease in Australia from a healthcare sector perspective. Methods A cost analysis including children with laboratory-confirmed iGAS disease hospitalised at the Royal Children’s Hospital (Victoria, Australia; July 2016 to June 2019) was performed. Results were extrapolated against the national minimum iGAS disease incidence. This analysis included healthcare cost from the 7 days prior to the index admission via General Practitioner (GP) and Emergency Department (ED) consultations; the index admission itself; and the 6 months post index admission via rehabilitation admissions, acute re-admissions and outpatient consultations. Additional extrapolations of national cost data by age group, Aboriginal and Torres Strait Islander ethnicity and jurisdiction were performed. Results Of the 65 included children, 35% (n = 23) were female, 5% (n = 3) were Aboriginal and Torres Strait Islander, and the average age was 4.4 years (SD 4.6; 65% aged 0–4). The iGAS disease related healthcare cost per child was $67,799 (SD $92,410). These costs were distributed across the 7 days prior to the index admission via GP and ED consultations (0.2 and 1.1% of total costs, respectively), the index admission itself (88.7% of the total costs); and the 6 months post index admission via rehabilitation admissions, acute re-admissions and outpatient consultations (5.3, 4.5 and 0.1% of total costs, respectively). Based on a national minimum paediatric incidence estimation of 1.63 per 100,000 children aged < 18 (95%CI: 1.11–2.32), the total annual healthcare cost for children with iGAS in 2019 was $6,200,862. The financial burden reflects the overrepresentation of Aboriginal and Torres Strait Islander people in the occurrence of iGAS disease. Costs were concentrated among children aged 0–4 years (62%). Conclusion As these cost estimations were based on a minimum incidence, true costs may be higher. Strengthening of surveillance and control of iGAS disease, including a mandate for national notification of iGAS disease, is warranted. Trial registration The current study is a part of ongoing iGAS surveillance work across seven paediatric health services in Australia. As this is not a clinical trial, it has not undergone trial registration.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The cost of care for children hospitalised with Invasive Group A Streptococcal Disease in Australia

Brusco

Oliver

McMinn

et al. 2021

BMC Health Serv Res

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“…Furthermore, the greatest burden is attributed to postinfection complications that can cause lifelong injuries and premature deaths, such as acute rheumatic fever and rheumatic heart disease. Estimations of global disease burden show alarming figures of 16–30 million severe and invasive disease cases, and 200 000–300 000 deaths in a given year 3‐6 . Despite being effective in treating infections, antibiotics have failed to reduce disease burden in less privileged areas where invasive GAS infections still cause high mortality rates, and superficial manifestations continue to consume substantial health care resources 7 …”

Section: Introductionmentioning

confidence: 99%

Pilus proteins from Streptococcus pyogenes stimulate innate immune responses through Toll‐like receptor 2

et al. 2022

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The group A Streptococcus (GAS) pilus is a long, flexible, hair‐like structure anchored to the cell surface that facilitates the adherence of GAS to host cells, thus playing a critical role in initiating infections. Because of its important role in GAS virulence, the pilus has become an attractive target for vaccine development. While current research mainly focuses on pilus function and its potential as a vaccine component, there is a lack of knowledge on how the host immune system recognizes and responds to this abundant surface structure. Here we show that both assembled GAS pili and individual pilus proteins induce a potent release of the proinflammatory cytokines tumor necrosis factor and interleukin‐8. We further show that the surface‐exposed backbone pilin and ancillary pilin 1 subunits are Toll‐like receptor 2 (TLR2) agonists. Using reporter cell lines coexpressing human TLR2 in combination with either TLR1 or TLR6, we determined that activation was mediated by the TLR2/TLR6 heterodimer. Finally, we used solid‐phase and flow cytometry binding assays to illustrate a direct interaction between the pilus subunits and TLR2. These results provide further support for the suitability of the pilus as a vaccine component and opens potential avenues for using GAS pili as an adjuvant or immune‐modulation agent.

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“…To the Editor: The toll of group A Streptococcus is dramatically unappreciated, despite increasing evidence of its burden 1 . In Australia and New Zealand, we recently demonstrated that group A streptococcal throat and skin infections cause a sizable burden at the population level — cellulitis is the main contributor to the total burden of all group A streptococcal diseases and acute rheumatic fever and rheumatic heart disease contribute disproportionately relative to their frequency of occurrence 2,3 …”

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confidence: 99%

Time to address the neglected burden of group A Streptococcus

Cannon

Bennett

Baker

et al. 2021

Medical Journal of Australia

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The economic and health burdens of diseases caused by group A Streptococcus in New Zealand

Cited by 23 publications

References 27 publications

The cost of care for children hospitalised with Invasive Group A Streptococcal Disease in Australia

The cost of care for children hospitalised with Invasive Group A Streptococcal Disease in Australia

Pilus proteins from Streptococcus pyogenes stimulate innate immune responses through Toll‐like receptor 2

Time to address the neglected burden of group A Streptococcus

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