Long-term healthcare utilisation, costs and quality of life after invasive group B Streptococcus disease: a cohort study in five low-income and middle-income countries

• Published in: BMJ global health Vol. 9; no. 5; p. e014367
• Main Authors: Seedat, Farah, Procter, Simon R, Dangor, Ziyaad, Leahy, Shannon, Santhanam, Sridhar, John, Hima B, Bassat, Quique, Aerts, Celine, Abubakar, Amina, Nasambu, Carophine, Libster, Romina, Yanotti, Clara Sánchez, Paul, Proma, Chanda, Jaya, Gonçalves, Bronner P, Horváth-Puhó, Erzsébet, Lawn, Joy E, Jit, Mark
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 14-05-2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Adolescent; Argentina; Caregivers; Child; Child health; Child, Preschool; Cohort analysis; Cohort Studies; Cohort study; Confounding (Statistics); Cost analysis; Developing Countries; Economics; Epidemiology; Families & family life; Female; Health care; Health Care Costs - statistics & numerical data; Health services utilization; Hospitals; Humans; Immunization; Income; India; Infant; Infections, diseases, disorders, injuries; Kenya; Low income groups; Male; Meningitis; Mortality; Mozambique; Original Research; Outpatient care facilities; Patient Acceptance of Health Care - statistics & numerical data; Quality of Life; Sepsis; South Africa; Streptococcal Infections - economics; Streptococcus agalactiae; Streptococcus infections; Surveillance; Vaccines; Young Adult; Young adults; South Africa; Argentina; Mozambique; Kenya; India; United Kingdom > UK; Asia; Africa; Denmark; Infections, diseases, disorders, injuries; Epidemiology; Cohort study; Child health
• ISSN: 2059-7908; 2059-7908
• DOI: 10.1136/bmjgh-2023-014367

IntroductionThere 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.MethodsInpatient 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.Results161 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).ConclusionThe 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.