Elsevier

Vaccine

Volume 32, Issue 39, 3 September 2014, Pages 5006-5012
Vaccine

Costs of surviving meningococcal disease in Spain: Evaluation for two cases of severe meningitis and septicaemia

https://doi.org/10.1016/j.vaccine.2014.07.019Get rights and content

Highlights

Abstract

Objectives

The aim of this study was to count the lifelong rehabilitation costs associated with surviving meningococcal disease with major sequelae from the perspective of the Spanish National Healthcare System (NHS) and the national government.

Methods

Two severe scenarios describing meningococcal disease were developed, one case that represented meningococcal septicaemia and another case for meningococcal meningitis. The scenarios were developed based on a literature review on severe sequelae of meningococcal disease, and discussions with paediatricians who have been responsible for the treatment of children with this disease in Spain. Second, a detailed list of all health, educational and social care resources used by survivors during their acute illness and during the rest of their lives and by family members was obtained by interviewing survivors and their families. Professionals in health and social care were also interviewed to complete the list of resources and ensure the scenario's were accurate. The costs attributed to these resources were obtained from tariff lists, catalogues and published information by the national authorities. All costs were based on a life expectancy of a survivor of 70 years and expressed in EUR 2012.

Results

In this study it was estimated that the lifelong discounted rehabilitation costs associated with the treatment of long-term sequelae due to meningococcal disease are approximately €1180,000–€1400,000. Medical care and social care were the main cost drivers for both septicaemia and meningitis. Annual costs showed to be the largest in the first year after diagnosis of the disease for both cases, due to high hospital admission and medical care costs during this period and decreased significantly over the years.

Conclusion

This study shows that the lifelong rehabilitation costs associated with the survival of meningococcal disease with severe sequelae place an important burden on the NHS budget and governmental resources in Spain.

Introduction

Meningococcal disease is caused by the microorganism Neisseria meningitidis, a bacterium that usually colonises the nasopharynx asymptomatically but occasionally can invade the host causing meningococcal septicaemia or meningitis [1]. The incidence of meningococcal disease in Spain was estimated at approximately 0.96 per 100,000 inhabitants in the period 2009–2010 and 70% of the cases were caused by an infection of the bacterium with serogroup B [2]. Most of the patients with meningococcal disease survive relatively unscathed, but some patients are left with severe long-term sequelae and disability [3].

Sequelae associated with surviving meningococcal disease depend on the type of infection that occurred and can include limb loss (3% of patients), growth plate damage, renal failure, skin necrosis/scarring and pain (21–28% of patients) for septicaemia [3], [4], [5], [6]. Sequelae associated with meningitis include mental disability, neurological sequelae (7% of patients) such as seizures, motor impairment, hydrocephalus, loss of vision and hearing loss (4% of patients) [3], [7].

Several studies have been identified [3], [8], [9], two in Spain and one in the United Kingdom, that evaluated the costs associated with meningococcal disease or with one of the manifestations of meningococcal disease. The study by Iñigo et al. [8] evaluated the associated hospitalisation costs of severe sepsis in the region of Madrid in Spain for the year 2001. They showed that hospitalisation costs summed up to approximately €10.000 per case of severe sepsis. In another study performed by Gil Prieto et al. [9] it was observed that the overall hospitalisation costs per patient with meningococcal disease came to €4918 and the average annual hospitalisation costs summed up to €592,980 in the region of Madrid over the period 1997–2005. To date only one study has been identified that counted the lifelong rehabilitation costs of surviving meningococcal disease [3]. This study was performed in the UK and showed that surviving meningococcal disease with major sequelae is associated with an important burden for the NHS and government. Accurate data on the costs-of-illness of meningococcal disease is fundamental for health economic evaluations as cost-effectiveness analyses and immunisation programmes. On its turn an increase in analyses on immunisation programmes has been observed in Spain [10], [11]. Although there has been an improvement in the methodological quality of studies it is clear that the existence of a huge gap in this kind of work compared to other countries [10], [11].

Lifelong rehabilitation costs in the UK were shown to vary between approximately £1360,000 and £1720,000 for a survivor with severe sequelae due to sepsis and meningitis [3]. The major sequelae associated with surviving meningococcal disease are also associated with an important loss of quality of life [5], [6]. Up to date no studies on the lifetime rehabilitation costs associated with surviving meningococcal disease with major sequelae in Spain have been identified. The objective of this study is to count the lifelong rehabilitation costs associated with surviving meningococcal disease with major sequelae in the Spanish setting. The results are presented in a format suitable for input into further health economic evaluations including cost-effectiveness analysis. As cost-effectiveness studies play a crucial role in determining whether immunisation programmes will be implemented, it is important to identify these costs.

Section snippets

Scenarios and resources

The approach used to estimate the lifelong rehabilitation costs associated with the survival of meningococcal disease consisted of three consecutive steps. First, two scenarios describing severe cases of meningococcal disease with major sequelae were developed. One described a case of acute meningococcal septicaemia (patient A) and the other described a case of meningococcal meningitis (patient B). Second, a list of health, educational, social care and other resources used by survivors during

Patient A

Patient A was diagnosed with meningococcal septicaemia at 12 months of age; suffering from severe septic shock, acute respiratory distress syndrome and renal failure for which he was treated at the Paediatric Intensive Care Unit (PICU). His respiratory and renal problems were resolved but he developed gangrene of the limbs due to purpura fulminans, leading to amputation of both legs above knee and one arm above the elbow. He spent 31 days on the PICU after which he was transferred to a

Discussion

Surviving meningococcal disease with long-term sequelae is associated with lifelong discounted rehabilitation costs ranging from €1180,000 to €1400,000. The first year alone was already responsible for the largest annual costs, ranging from €110,000 to €140,000. After the first year after the onset of the disease the costs for patient A showed to decrease over time. The main reasons for this decrease were due to less frequent changing of prosthetic provisions. On the contrary, annual costs

Conclusion

This study shows that the lifelong costs associated with the survival of meningococcal disease with severe sequelae place an important burden on the NHS budget and governmental resources in Spain as well as at regional level for the four regions of interest including Catalonia, Galicia Andalusia, and Madrid. These results fill a gap in the current knowledge on the medical costs, educational costs and social care costs associated with surviving meningococcal disease with major sequelae for the

Contributors

Lisette Kaskens is an employee of BCN Health Economics and Outcomes Research, Barcelona, Spain, a consultancy hired by Novartis, to adapt the model to count the costs for meningococcal disease by interviewing health professionals and patients to produce the patient scenarios, collecting the costs and writing the manuscript… Josep Darbà was involved as an external advisor hired by Novartis from the Universitat de Barcelona and responsible for the review of the data and the manuscript. Mareille

Funding

Unrestricted educational grants from Novartis, provided funding for the study to take place.

Acknowledgments

The authors would like to thank the paediatricians, neurosurgeon, plastic surgeon, neurologist, consultant in rehabilitation medicine, traumatologist, otolaryngologist, psychologist, social worker and speech therapist for their assistance provided during the study. We would also like to thank the families of children and affected adults by meningococcal disease who participated in the study by sharing their experiences. The authors wish to thank Lisa Martial, a former employee of BCN Health

References (32)

  • J. Iñigo et al.

    Epidemiología y costes de la sepsis grave en Madrid. Estudio de altas hospitalarias

    Med. Intensiva (Barc.)

    (2006)
  • Diario Oficial de la Generalitat de Catalunya (DOGC)

    Diario Oficial de la Generalitat de Catalunya (DOGC) Núm. 6079

    (2012)
  • Diario Oficial de Galicia (DOG)

    Diario Oficial de Galicia (DOG) Núm. 213

    (2011)
  • Boletín Oficial de la Junta de Andalucía (BOJA)

    Boletín Oficial de la Junta de Andalucía (BOJA) Núm. 210

    (2005)
  • Sistema Nacional de Salud

    Pesos de los GRDs del Sistema Nacional de Salud

    (2008)
  • Comunidad de Madrid (BOCM)

    Boletín Oficial de la Comunidad de Madrid (BOCM) Núm. 215

    (2009)
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