TY - JOUR
T1 - Long-term healthcare utilisation, costs and quality of life after invasive group B Streptococcus disease
T2 - a cohort study in five low-income and middle-income countries
AU - The GBS Long-Term Outcomes LMIC Collaborative Group
AU - Seedat, Farah
AU - Procter, Simon
AU - Dangor, Ziyaad
AU - Leahy, Shannon
AU - Santhanam, Sridhar
AU - John, Hima B.
AU - Bassat, Quique
AU - Aerts, Celine
AU - Abubakar, Amina
AU - Nasambu, Carophine
AU - Libster, Romina
AU - Yanotti, Clara Sánchez
AU - Paul, Proma
AU - Chanda, Jaya
AU - Gonçalves, Bronner P.
AU - Horváth-Puhó, Erzsébet
AU - Lawn, Joy E.
AU - Jit, Mark
AU - Madhi, Shabir A.
AU - Harden, Lois
AU - Ghoor, Azra
AU - Mbatha, Sibongile
AU - Lowick, Sarah
AU - Jaye, Tamara
AU - Lala, Sanjay G.
AU - Sithole, Pamela
AU - Msayi, Jacqueline
AU - Kumalo, Ntombifuthi
AU - Msibi, Tshepiso Nompumelelo
AU - Arumugam, Asha
AU - Murugesan, Nandhini
AU - Rajendraprasad, Nandhini
AU - Priya, Mohana
AU - Adan, Adam Mabrouk
AU - Katana, Patrick Vidzo
AU - Mwangome, Eva
AU - Newton, Charles R.
AU - Bardají, Azucena
AU - Bramugy, Justina
AU - Mucasse, Humberto
AU - Massora, Sergio
AU - Medina, Valeria
AU - Rojas, Andrea
AU - Amado, Daniel
AU - Llapur, Conrado J.
AU - Hossain, A. K.M.Tanvir
AU - Rahman, Qazi Sadeq Ur
N1 - Publisher Copyright:
© 2024 BMJ Publishing Group. All rights reserved.
PY - 2024/5/14
Y1 - 2024/5/14
N2 - Introduction There are no published data on the long-term impact of invasive group B Streptococcus disease (iGBS) on economic costs or health-related quality of life (HRQoL) in low-income and middle-income countries. We assessed the impact of iGBS on healthcare utilisation, costs and HRQoL in Argentina, India, Kenya, Mozambique and South Africa. Methods Inpatient and outpatient visits, out-of-pocket (OOP) healthcare payments in the 12 months before study enrolment, and health-state utility of children and caregivers (using the EuroQol 5-Dimensions-3-Level) were collected from iGBS survivors and an unexposed cohort matched on site, age at recruitment and sex. We used logistic or Poisson regression for analysing healthcare utilisation and zero-inflated gamma regression models for family and health system costs. For HRQoL, we used a zero-inflated beta model of disutility pooled data. Results 161 iGBS-exposed and 439 unexposed children and young adults (age 1-20) were included in the analysis. Compared with unexposed participants, iGBS was associated with increased odds of any healthcare utilisation in India (adjusted OR 11.2, 95% CI 2.9 to 43.1) and Mozambique (6.8, 95% CI 2.2 to 21.1) and more frequent healthcare visits (adjusted incidence rate ratio (IRR) for India 1.7 (95% CI 1.4 to 2.2) and for Mozambique 6.0 (95% CI 3.2 to 11.2)). iGBS was also associated with more frequent days in inpatient care in India (adjusted IRR 4.0 (95% CI 2.3 to 6.8) and Kenya 6.4 (95% CI 2.9 to 14.3)). OOP payments were higher in the iGBS cohort in India (adjusted mean: Int$682.22 (95% CI Int$364.28 to Int$1000.16) vs Int$133.95 (95% CI Int$72.83 to Int$195.06)) and Argentina (Int$244.86 (95% CI Int$47.38 to Int$442.33) vs Int$52.38 (95% CI Int$-1.39 to Int$106.1)). For all remaining sites, differences were in the same direction but not statistically significant for almost all outcomes. Health-state disutility was higher in iGBS survivors (0.08, 0.04-0.13 vs 0.06, 0.02-0.10). Conclusion The iGBS health and economic burden may persist for years after acute disease. Larger studies are needed for more robust estimates to inform the cost-effectiveness of iGBS prevention.
AB - Introduction There are no published data on the long-term impact of invasive group B Streptococcus disease (iGBS) on economic costs or health-related quality of life (HRQoL) in low-income and middle-income countries. We assessed the impact of iGBS on healthcare utilisation, costs and HRQoL in Argentina, India, Kenya, Mozambique and South Africa. Methods Inpatient and outpatient visits, out-of-pocket (OOP) healthcare payments in the 12 months before study enrolment, and health-state utility of children and caregivers (using the EuroQol 5-Dimensions-3-Level) were collected from iGBS survivors and an unexposed cohort matched on site, age at recruitment and sex. We used logistic or Poisson regression for analysing healthcare utilisation and zero-inflated gamma regression models for family and health system costs. For HRQoL, we used a zero-inflated beta model of disutility pooled data. Results 161 iGBS-exposed and 439 unexposed children and young adults (age 1-20) were included in the analysis. Compared with unexposed participants, iGBS was associated with increased odds of any healthcare utilisation in India (adjusted OR 11.2, 95% CI 2.9 to 43.1) and Mozambique (6.8, 95% CI 2.2 to 21.1) and more frequent healthcare visits (adjusted incidence rate ratio (IRR) for India 1.7 (95% CI 1.4 to 2.2) and for Mozambique 6.0 (95% CI 3.2 to 11.2)). iGBS was also associated with more frequent days in inpatient care in India (adjusted IRR 4.0 (95% CI 2.3 to 6.8) and Kenya 6.4 (95% CI 2.9 to 14.3)). OOP payments were higher in the iGBS cohort in India (adjusted mean: Int$682.22 (95% CI Int$364.28 to Int$1000.16) vs Int$133.95 (95% CI Int$72.83 to Int$195.06)) and Argentina (Int$244.86 (95% CI Int$47.38 to Int$442.33) vs Int$52.38 (95% CI Int$-1.39 to Int$106.1)). For all remaining sites, differences were in the same direction but not statistically significant for almost all outcomes. Health-state disutility was higher in iGBS survivors (0.08, 0.04-0.13 vs 0.06, 0.02-0.10). Conclusion The iGBS health and economic burden may persist for years after acute disease. Larger studies are needed for more robust estimates to inform the cost-effectiveness of iGBS prevention.
KW - Child health
KW - Cohort study
KW - Epidemiology
KW - Infections, diseases, disorders, injuries
UR - http://www.scopus.com/inward/record.url?scp=85193833744&partnerID=8YFLogxK
U2 - 10.1136/bmjgh-2023-014367
DO - 10.1136/bmjgh-2023-014367
M3 - Article
AN - SCOPUS:85193833744
SN - 2059-7908
VL - 9
JO - BMJ Global Health
JF - BMJ Global Health
IS - 5
M1 - e014367
ER -