Abstract
Chronic obstructive pulmonary disease (COPD) may increase the risk and severity of pertussis infection. Health care resource utilization (HCRU) and direct medical costs (DMC) of treating pertussis among patients with COPD are unknown. Reported incidence of pertussis among individuals aged ≥ 50 years with COPD was assessed in Clinical Practice Research Datalink and Hospital Episode Statistics databases during 2009–2018 using a retrospective cohort design. HCRU and DMC from the National Health Service perspective were compared between patients with COPD and pertussis and propensity score-matched patients with COPD without pertussis. Seventy-eight new pertussis events were identified among 387 086 patients with COPD aged ≥ 50 years (incidence rate: 4.73; 95% confidence interval 3.74–5.91 per 100 000 person-years). HCRU and DMC were assessed among 67 patients with COPD and pertussis and 267 matched controls. During the month before the pertussis diagnosis, the rates of general practitioner (GP)/nurse visits (4289 vs. 1774 per 100 patient-years) and accident and emergency visits (182 vs. 18 per 100 patient-years) were higher in the pertussis cohort; GP/nurse visits (2935 vs. 1705 per 100 patient-years) were also higher during the following 2 months (all p < 0.001). During the month before the pertussis diagnosis, annualized per-patient total DMC were £2012 higher in the pertussis cohort (£3729 vs. £1717; p < 0.001); during the following 2 months, they were £2407 higher (£5498 vs. £3091; p < 0.001). In conclusion, a pertussis episode among individuals with COPD resulted in significant increases in HCRU and DMC around the pertussis event.
Highlights
Pertussis is a highly contagious bacterial respiratory infection that is most commonly caused by Bordetella pertussis [1]
While comparisons between studies should be undertaken with caution, and only 87 patients were sampled, this implies that the actual incidence rate of pertussis infection could have been several hundred-fold higher than the reported incidence rates estimated in the current study
This study provides valuable information on real-world Health care resource utilization (HCRU) and direct medical costs (DMC) of treating patients with chronic obstructive pulmonary disease (COPD) and diagnosed pertussis compared to a matched cohort of patients with COPD only
Summary
Pertussis (whooping cough) is a highly contagious bacterial respiratory infection that is most commonly caused by Bordetella pertussis [1]. Key clinical features of pertussis are paroxysmal cough, inspiratory whooping, post-tussive vomiting, and absence of fever [2]. The clinical presentation of pertussis in adults is often atypical, with less than half of adults demonstrating the inspiratory whoop [3]. Paroxysmal cough and absence of fever have high sensitivity but low specificity for pertussis diagnosis, while inspiratory whooping and post-tussive vomiting have high specificity but low sensitivity [2]. Pertussis can present with other symptoms (e.g. shortness of breath, post-tussive apnea, disturbed sleep, and sore ribs) [4, 5] and complications (e.g. sinusitis, pneumonia, urinary incontinence, and rib fractures) [4, 6] and can result in hospitalization, among older adults [4, 7–10]. Pertussis can have a detrimental impact on quality of life (20–36 quality adjusted life days lost per laboratory confirmed episode) and result in time off work [5]. The morbidity of pertussis in older adults is reflected in substantial health care resource utilization (HCRU) and direct medical costs (DMC) [11–13]
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