Economic burden of bronchiectasis in Germany

Estimates of healthcare costs for incident bronchiectasis patients are currently not available for any European country. Out of a sample of 4 859 013 persons covered by German statutory health insurance companies, 231 new bronchiectasis patients were identified in 2012. They were matched with 685 control patients by age, gender and Charlson Comorbidity Index and followed for 3 years.The total direct expenditure during that period per insured bronchiectasis patient was €18,634.57 [95%CI: €15,891.02-€23,871.12], nearly one third higher (ratio of mean 1.31 [95%CI: 1.02-1.68]) than for a matched control (p<0.001).Hospitalisation costs contributed to 35% of the total and were more than 50% higher in the bronchiectasis group (1.56 [95%CI: 1.20-3.01]; p<0.001); on average, bronchiectasis patients spent 4.9 more days [95%CI: 2.27-7.43] in hospital (p<0.001). Antibiotics expenditures per bronchiectasis outpatient (€413.81) were nearly five times higher than those for a matched control (4.85 [95%CI 2.72-8.64]).Each bronchiectasis patient had on average 40.5 [95%CI: 17.1-43.5] sick leave days and induced work-loss costs of €4,230.49 [95%CI: €2,849.58-€5,611.20].The mortality rate for bronchiectasis and matched non-bronchiectasis patients after 3 years of follow up was 26.4% and 10.5%, respectively (p<0.001). Mortality in the bronchiectasis group was higher among those who also had COPD than in patients with bronchiectasis alone (35.9% and 14.6%, respectively; p<0.001).Although bronchiectasis is considered underdiagnosed, the mortality and associated financial burden in Germany are substantial.