Academic journal article Iranian Journal of Public Health

Costs of Hospital Admission on Primary Immunodeficiency Diseases

Academic journal article Iranian Journal of Public Health

Costs of Hospital Admission on Primary Immunodeficiency Diseases

Article excerpt


Primary immunodeficiency diseases (PID) are characterized by defects in the immune system, mainly due to single gene defect (1). This heterogeneous, inherited group of diseases led to absent or reduced function in one or more components of the immune system, leading to variable immune-related complications (2).

Recurrent mucosal infections, persistent fungal infection, deep organ abscesses, enteropathy, granulomatous lesions, opportunistic infections, autoimmunity, lymphoproliférative disorders, and malignancies are the most important manifestations of PID patients (3, 4). Early detection, preventing complications, and adequate treatments are the keys to reducing morbidity and mortality of patients (5-7). Although the true prevalence of PID is unknown, it is not considered as a rare condition (8-11). Physician awareness could lead to better identification of diseases. Although prevalence of each type of PID differs from others, ethnicity and consanguinity could change the incidence pattern of disease, especially in those with autosomal recessive inheritance (12, 13).

Patients with PID usually experience several hospital admissions, especially in emergency, immunology, and infectious diseases wards (14, 15). Antibiotic and antifungal agents are the mainstay treatment to control, prevent and manage chronic and recurrent infections. Immunoglobulin replacement therapy both intravenously and subcutaneously is another effective therapy in antibody deficiencies, also recommended for treatment of many patients with other forms of PID associating hypogammaglobulinemia (5). Other therapeutic approaches include cytokine therapy, enzyme replacement, vaccinations and hematopoietic stem cell transplantation (HSCT) (5).

Nowadays, economic analyses importance has been at the center of attention also in health system, predominantly with respect to health policy making for specific diseases and pharmaceutical recourses (16). In this cost-conscious environment, it is important to evaluate exact costs of diseases to choose less therapeutic modalities with high effectiveness to achieve better outcomes (17). This valuable knowledge will illuminate treatment guideline and health budgeting.

One of the most important sections of estimating financial burden of disease is admission cost, which is crucial for proper decision-making process. Evaluation of admission expenditures can assist health care providers into two goals of budget assignment for medication and cares as well as investigating efficiency of different health interventions by means of either cost-benefit or cost-effectiveness analysis (18). Although burden of some special PID disease was measured (1921), there is no specific data regarding the cost and economic burden of whole PID group.

This study was designed to estimate the admission cost of PID in the main referral hospital.

Materials and Methods

Study environment

During the period of study from Jan 2011 to Jan 2012, the patients with diagnosis of PID hospitalized in the Children's Medical Center Hospital, Tehran, Iran were enrolled in the study. This hospital is the Pediatrics Center of Excellence in Iran affiliated to Tehran University of Medical Sciences, also known as the main referral center for PID patients. The research center for immunodeficiency located in this hospital is the documenting center of European society for Immunodeficiency and PID patients are diagnosed and treated in this center based on the updated standardized guidelines (22). Therefore, the registered costs for the patients admitted to this tertiary center can be a representative for direct economic costs due to hospitalization inpatient with definite PID diagnosis.

The process of this study was approved by the Ethics Committee of the Tehran University of Medical Sciences, Iran and the extracted data were anonymized for further analysis.

Patient recruitment

The patients were included in the survey, based on the International Classification of Diseases-10 (ICD-10) code, which extracted from Chapter III (Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism; D50-D89) (23). …

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