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Estimating Direct Cost of Cystic Fibrosis Care Using Irish Registry Healthcare Resource Utilisation Data, 2008–2012

Author

Listed:
  • Abaigeal D. Jackson

    (UCD Belfield)

  • Andrew L. Jackson

    (Trinity College Dublin)

  • Godfrey Fletcher

    (UCD Belfield)

  • Gerardine Doyle

    (Quinn School of Business)

  • Mary Harrington

    (UCD Belfield)

  • Shijun Zhou

    (UCD Belfield)

  • Fiona Cullinane

    (UCD Belfield)

  • Charles Gallagher

    (St Vincent’s University Hospital)

  • Edward McKone

    (St Vincent’s University Hospital)

Abstract

Background Understanding the determinants of cost of cystic fibrosis (CF) care and health outcomes may be useful for financial planning for the delivery of CF services. Registries contain information otherwise unavailable to healthcare activity/cost monitoring systems. We estimated the direct medical cost of CF care using registry data and examined how cost was affected by patient characteristics and CF gene (CF Transmembrane Conductance Regulator [CFTR]) mutation. Methods Healthcare resource utilisation data (2008–2012) were obtained for CF patients enrolled with the Irish CF Registry by 2013 from linked registry and national hospitalisation database records. Mean annual hospitalisation and medication per-patient costs were estimated by demographic profile, CFTR mutation, clinical status, and CF co-morbidity, and were presented in 2014 euro values. A mixed-effects regression model was used to examine the effect of demographic, CFTR mutation, and clinical outcomes on the log10 cost of direct medical CF care. Results Using 4261 observations from 1100 patients, we found that the median annual total cost per patient increased over the period 2008–2012 from €12,659 to €16,852, inpatient bed-day cost increased from €14,026 to €17,332, and medication cost increased from €5863 to €12,467. Homozygous F508-CFTR mutation (class II) cost was highest and milder mutation (class IV/V) cost was 49% lower. Baseline estimated cost in 2008 for a hypothetical underweight, homozygous F508del-CFTR 6-year-old female without chronic Pseudomonas aeruginosa/Staphylococcus aureus, CF-related diabetes (CFRD) or methicillin-resistant S. aureus (MRSA), and with a poor percent predicted forced expiratory volume in 1 s (ppFEV1) was €10,113, and was €21,082 in a 25-year-old with the same hypothetical profile. Chronic P. aeruginosa infection increased baseline cost by 39%, CF co-morbidity diabetes by 18%, and frequency of pulmonary exacerbation by 15%. Underweight, declining ppFEV1, chronic S. aureus colonisation, and time also influenced cost. Conclusions CFTR mutation is an important factor influencing the cost of CF care. Costs differ among cohorts of CF patients eligible to access new and emerging CFTR repair therapies. These findings support the evaluation of outcome-associated cost in CFTR mutation-specific CF patient groups.

Suggested Citation

  • Abaigeal D. Jackson & Andrew L. Jackson & Godfrey Fletcher & Gerardine Doyle & Mary Harrington & Shijun Zhou & Fiona Cullinane & Charles Gallagher & Edward McKone, 2017. "Estimating Direct Cost of Cystic Fibrosis Care Using Irish Registry Healthcare Resource Utilisation Data, 2008–2012," PharmacoEconomics, Springer, vol. 35(10), pages 1087-1101, October.
  • Handle: RePEc:spr:pharme:v:35:y:2017:i:10:d:10.1007_s40273-017-0530-4
    DOI: 10.1007/s40273-017-0530-4
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    References listed on IDEAS

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    1. Daniela Eidt-Koch & Thomas Wagner & Thomas Mittendorf & J.-Matthias Schulenburg, 2010. "Outpatient medication costs of patients with cystic fibrosis in Germany," Applied Health Economics and Health Policy, Springer, vol. 8(2), pages 111-118, March.
    2. Kees Van Gool & Richard Norman & Martin B Delatycki & Jane Hall & John Massie, 2011. "Understanding the costs of care for cystic fibrosis: an analysis by age and severity. CHERE Working Paper 2011/1," Working Papers 2011/1, CHERE, University of Technology, Sydney.
    3. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453.
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