Academic journal article Applied Health Economics and Health Policy

Hospital Costs, Length of Stay and Mortality Associated with Childhood, Adolescent and Young Adult Meningococcal Disease in the US

Academic journal article Applied Health Economics and Health Policy

Hospital Costs, Length of Stay and Mortality Associated with Childhood, Adolescent and Young Adult Meningococcal Disease in the US

Article excerpt

Introduction

Approximately 5-10% of the US population carries the meningococcal bacteria Neisseria meningitidis (meningococcus) in a harmless state within the upper respiratory tract.[1] Occasionally these bacteria will establish an infection, which is known as invasive meningococcal disease (IMD). Between 1400 and 3000 cases of IMD have occurred each year in the US over the past decade, with an estimated annual incidence between 0.5 and 1.5 cases per 100 000 individuals.[2-6] The disease has recently declined to an incidence of 0.34 per 100 000 in 2008.[7] Although people of all ages are susceptible to IMD, children, adolescents and young adults are at the highest risk.[8,9] The incidence of IMD in paediatrics has two peaks: it is highest in infants aged <1 year, but a second lower peak occurs in adolescents. In 2000, the estimated annual incidence of IMD in infants was 7.6 cases per 100 000[10] and, by 2008, the incidence declined to 3.6 per 100 000.[7] Despite the recent decline in IMD incidence among infants, in 2008 the incidence was still higher among infants relative to children and young adults: more than 20 times the rate in 11- to 17-year-old adolescents and nearly six times the rate in young adults aged 18-22 years.[7]

The proportion of IMD cases caused by serogroup Y increased from 2% in the late 1980s[11] to 37% in the late 1990s and early 2000s.[3] Currently, serogroups B, C and Y are the major causes of IMD in the US. The proportion of cases caused by each serogroup varies by age group. More than half of IMD cases among infants aged <1 year are caused by serogroup B, for which no vaccine is licensed or available in the US.[12]

While the advent of vaccines for the bacterial organisms Haemophilus influenzae and Streptococcus pneumoniae has substantially curtailed rates of invasive bacterial infections in the US,[13,14] invasive bacterial infections caused by N. meningitidis continue to be a public health concern due to their serious and sometimes fatal consequences. The most recent and definitive study of the epidemiology of IMD in the US analysed data from confirmed Neisseria meningitidis isolates collected over a 10-year period from 1998 to 2007 from Active Bacterial Core surveillance (ABCs) sites in all 50 states.[6] The study reported that 11.3% of all IMD cases during this period were fatal.[6] In the US, IMD is now the most common cause of death due to infection in children, adolescents and young adults.[3] Among IMD cases aged <65 years, adolescents and young adults carry the highest case-fatality rate, at approximately 10-14%.[6] In addition to high mortality risk, approximately 11-19% of survivors will experience serious, potentially debilitating complications such as limb amputation, hearing loss and deafness, visual impairment, brain and nervous system damage, seizure and stroke.[15,16]

Because of the high risk of death, severe clinical sequelae, and ongoing potential for outbreaks, prevention of IMD through the use of vaccines has become a public health priority. A new meningococcal conjugate vaccine (MCV4) was approved for immunization in the US in 2005 for all those aged 11-55 years, and then in 2008.[15] A second MCV4 vaccine for persons aged 11-55 years was licensed in US in 2010, with extension to children aged 2-10 years expected in 2011. While there is currently an unmet medical need in infants, meningococcal vaccines for this age group may be licensed in the near future. As more meningococcal vaccination strategies become available, informed economic evaluations will become increasingly important.

Assessments of vaccination programmes should account for several important factors, including efficacy, safety and costs of preventing and treating the disease.[17] Because patients with IMD are managed primarily in an inpatient setting, particularly during the acute phase of infection, hospital costs and outcomes are central endpoints in health economic evaluations of IMD. …

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