The burden of selected vaccine-preventable diseases on the secondary care health system in England: Results from a five-year administrative healthcare dataset

• Published in: Vaccine Vol. 40; no. 48; pp. 6939 - 6946
• Main Authors: Rabe, Adrian Paul J., Costello, Paul, Were, John J., Farrer, Archie, Hudson, Richard D.A.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 15-11-2022; Elsevier Limited
• Subjects: Adult; Adults; Age; Antigens; Datasets; Diagnosis; Diphtheria; Diphtheria-Tetanus-Pertussis Vaccine; Economic burden; Haemophilus Infections - epidemiology; Haemophilus influenzae type b; Haemophilus Vaccines; Health care; Health services; Hepatitis; Hepatitis B; Hepatitis B Vaccines; Hospital costs; Humans; Immunization; Infant; Infectious diseases; Injections; Length of stay; Mortality; Patients; Pertussis; Poliomyelitis; Public health; Retirement; Secondary Care; Secondary healthcare; State Medicine; Tariffs; Tetanus; Vaccination; Vaccine-Preventable Diseases; Vaccines; Vaccines, Combined; Whooping cough; Whooping Cough - epidemiology; Whooping Cough - prevention & control; United Kingdom > UK; England; Vaccine-preventable diseases; Secondary healthcare; Economic burden; Vaccines
• ISSN: 0264-410X; 1873-2518
• DOI: 10.1016/j.vaccine.2022.10.015

•Resurgence of VPDs has been observed in England. The number of NHS 2ndry care episodes relating to 6 VPDs is reported here.•We show that these VPDs are associated with substantial cost and resource use burden on the healthcare system.•Notably an unexpectedly high number of polio cases was observed here whereas the PHE surveillance data report only one case.
This study examined healthcare resource use (HCRU) for selected vaccine-preventable diseases (VPD) in secondary care in England.
The hospital episode statistics (HES) dataset covering all secondary care interactions within the English National Health Service (NHS) from 2015 to 2021 was used to identify and track HCRU for patients with a primary or secondary diagnosis for pertussis and Haemophilus influenzae type b (Hib), or a primary diagnosis only for hepatitis B, diphtheria, poliomyelitis, or tetanus. The first documented diagnosis during the study period (01/04/2015–31/03/2021) was the index event.
7,274 patients with a total of 5,554,343 patient-days (mean follow up 1,491 days) were included. The total number of hospital admissions was 27,092 and total inpatient cost was £4,987,770, with hepatitis B making up ∼80 % of this. Mean outpatient hospital appointments per patient were highest for tetanus (4.00), but total outpatient A&E cost burden was highest for Hib (£643,343 [mean per attendance £144.57]). For patients 0–9 years of age (n = 1,917), pertussis (n = 1,547) and Hib (n = 313) were by far the most commonly coded diseases. Hepatitis B was the most common disease in adults of working age and Hib was most prevalent in adults of retirement age. Surprisingly, poliomyelitis was observed in the database potentially due to historic diagnoses and/or coding inaccuracy. Other discrepancies with surveillance data were noted.
VPDs impose a large burden on the NHS, but there is potential to reduce this and improve public health by optimising vaccination schedules, improving access and ensuring high coverage rates.