Cost of care for cystic fibrosis: an investigation of cost determinants using national registry data

• Published in: The European journal of health economics 2015-09, Vol.16 (7), p.709-717
• Main Authors: Gu, Yuanyuan, García-Pérez, Sonia, Massie, John, van Gool, Kees
• Format: Article
• Language: English
• Subjects: Adult; Age; Age Factors; Australia; Bacterial diseases; Bacterial infections; Bacterial Infections - complications; Bacterial Infections - economics; Body mass index; Chronic Disease - economics; Chronic illnesses; Computer Simulation; Cost control; Costs; Cystic fibrosis; Cystic Fibrosis - economics; Cystic Fibrosis - genetics; Cystic Fibrosis - microbiology; Dependent variables; Drug prices; Economic Policy; Female; Forced Expiratory Volume; Gender; Health Care Costs - statistics & numerical data; Health care expenditures; Health Care Management; Health care policy; Health Economics; Hospitalization - economics; Humans; Hypotheses; Male; Medicine; Medicine & Public Health; Methicillin-Resistant Staphylococcus aureus; Mutation; Original Paper; Patients; Pharmacoeconomics and Health Outcomes; Public Finance; Public Health; Registries; Regression Analysis; Regulation; Staphylococcal Infections - complications; Staphylococcal Infections - economics; Transplants & implants; Variables; Young Adult
• ISSN: 1618-7598; 1618-7601
• DOI: 10.1007/s10198-014-0621-5

Cystic fibrosis (CF) is a progressive disease with treatments intensifying as patients get older and severity worsens. To inform policy makers about the cost burden in CF, it is crucial to understand what factors influence the costs and how they affect the costs. Based on 1,060 observations (from 731 patients) obtained from the Australian Data Registry, individual annual health care costs were calculated and a regression analysis was carried out to examine the impact of multiple variables on the costs. A method of retransformation and a hypothetical patient were used for cost analysis. We show that an additional one unit improvement of FEVlpp (i.e., forced expiratory volume in 1 s as a percentage of predicted volume) reduces the costs by 1.4 %, or for a hypothetical patient whose FEVlpp is 73 the cost reduction is A$252. The presence of chronic infections increases the costs by 69.9-163.5 % (A$ 12,852-A$30,047 for the hypothetical patient) depending on the type of infection. The type of CF genetic mutation and the patient's age both have significant effects on the costs. In particular, being homozygous for p.F508del increases the costs by 26.8 % compared to all the other gene mutations. We conclude that bacterial infections have a very strong influence on the costs, so reducing both the infection rates and the severity of the condition may lead to substantial cost savings. We also suggest that the patient's genetic profile should be considered as an important cost determinant.