Abstract
ObjectiveTo determine 1-year attributable healthcare costs of bronchiolitis.MethodsUsing a population-based matched cohort and incidence-based cost analysis approach, we identified infants <12 months old diagnosed in an emergency department (ED) or hospitalized with bronchiolitis between April 1, 2003 and March 31, 2014. We propensity-score matched infants with and without bronchiolitis on sex, age, income quintile, rurality, co-morbidities, gestational weeks, small-for-gestational-age status and pre-index healthcare cost deciles. We calculated mean attributable 1-year costs using a generalized estimating equation model and stratified costs by age, sex, income quintile, rurality, co-morbidities and prematurity.ResultsWe identified 58,375 infants with bronchiolitis (mean age 154±95 days, 61.3% males, 4.2% with comorbidities). Total 1-year mean bronchiolitis-attributable costs were $4,313 per patient (95%CI: $4,148–4,477), with $2,847 (95%CI: $2,712–2,982) spent on hospitalizations, $610 (95%CI: $594–627) on physician services, $562 (95%CI: $556–567)] on ED visits, $259 (95%CI: $222–297) on other healthcare costs and $35 ($27–42) on drugs. Attributable bronchiolitis costs were $2,765 (95%CI: $2735–2,794) vs $111 (95%CI: $102–121) in the initial 10 days post index date, $4,695 (95%CI: $4,589–4,800) vs $910 (95%CI: $847–973) in the initial 180 days and $1,158 (95%CI: $1,104–1213) vs $639 (95%CI: $599–679) during days 181–360.Mean 1-year bronchiolitis costs were higher in infants <3 months old [$5,536 (95%CI: $5,216–5,856)], those with co-morbidities [$17,530 (95%CI: $14,683–20,377)] and with low birthweight [$5,509 (95%CI: $4,927–6,091)].ConclusionsCompared to no bronchiolitis, bronchiolitis incurs five-time and two-time higher healthcare costs within the initial and subsequent six-months, respectively. Most expenses occur in the initial 10 days and relate to hospitalization.
Highlights
Bronchiolitis is a viral disease characterized by rhinorrhea, cough and respiratory distress, typically affecting infants under 12 months of age [1]
We identified 58,375 infants with bronchiolitis
Mean 1-year bronchiolitis costs were higher in infants
Summary
Bronchiolitis is a viral disease characterized by rhinorrhea, cough and respiratory distress, typically affecting infants under 12 months of age [1]. More than a third of all infants develop bronchiolitis, of whom 3% are admitted to hospital [2]. Bronchiolitis carries high morbidity; it represents the leading cause of infant hospitalizations in the Western world, with increasing costs over the past several decades [1,14,15]. In the United States, bronchiolitis-related annual hospitalization expenses exceed $500 million [16,17], with comparable economic burden in other Western countries [18]. The reported mean annual healthcare utilization for bronchiolitis per 1000 infants under 6 months of age is 17 hospitalizations, 55 ED visits and 132 unplanned office visits [15]
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