Lifetime patient outcomes and healthcare utilization for Bronchopulmonary dysplasia (BPD) and extreme preterm infants: a microsimulation study

Sasha Van Katwyk,Bernard Thébaud,Kednapa Thavorn,Sajit Augustine

doi:10.1186/s12887-020-02037-5

Abstract

BackgroundBronchopulmonary dysplasia (BPD) is among the most severe chronic lung diseases and predominantly affects premature infants. There is a general understanding of BPD’s significant impact on the short-term outcomes however there is little evidence on long-term outcomes. Our study estimates the lifetime clinical outcomes, quality of life, and healthcare costs of BPD and associated complications.MethodsWe developed a microsimulation model to estimate lifetime clinical and economic burden of BPD among extreme preterm infants (≤28 weeks gestational age at birth) and validated it against the best available Canadian data. We further estimate the cumulative incidence of major complications associated with BPD, differentiated by BPD severity and gestational age category.ResultsWe find, on average, patients with BPD and resulting complications will incur over CAD$700,000 in lifetime health systems costs. We also find the average life expectancy of BPD patients to be moderately less than that of the general population and significant reductions in quality-adjusted life year due to major complications. Healthcare utilization and quality of life measures vary dramatically according to BPD severity, suggesting significant therapeutic headroom for interventions that can prevent or mitigate the effects of BPD for patients.ConclusionsOur study adds a significant expansion of existing evidence by presenting the lifetime burden of BPD based on key patient characteristics. Given the extreme cost burden at the earliest stage of life and lifetime negative impact on quality of life, there is larger headroom for investment in prevention and mitigation of severe BPD than is currently available.

Highlights

Bronchopulmonary dysplasia (BPD) is among the most severe chronic lung diseases and predominantly affects premature infants
While there is some evidence on the immediate cost of BPD during and immediately following birth admission [2, 3], little is known about the long-term healthcare utilization and costs associated with BPD, or how these costs differ across a population that is known to be heterogeneous in BPD severity and subsequent complications
BPD is van Katwyk et al BMC Pediatrics (2020) 20:136 common among extremely preterm infants; those under 29 weeks gestational age at birth are at high risk of developing several severe chronic morbidities that are associated with BPD

Summary

Introduction

Bronchopulmonary dysplasia (BPD) is among the most severe chronic lung diseases and predominantly affects premature infants. Bronchopulmonary dysplasia (BPD) remains the most common complication of extreme prematurity It is associated with severe long-term co-morbidities that reduce patient life expectancy, quality of life, and increase healthcare costs [1]. While there is some evidence on the immediate cost of BPD during and immediately following birth admission [2, 3], little is known about the long-term healthcare utilization and costs associated with BPD, or how these costs differ across a population that is known to be heterogeneous in BPD severity and subsequent complications This is a considerable oversight as the majority of extreme preterm BPD patients do survive their first year of life, yet do so at extreme risk of developing multiple severe complications that will require lifetime treatment and care [4]. A model allows for the study and evaluation of the potential impacts of various intervention strategies for BPD, while being able to integrate new evidence as is arises

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