ECONOMIC DAMAGE OF PNEUMOCOCCAL VACCINATION ABSENCE AS A RISK FACTOR FOR COMPLICATIONS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

The aim of the article is the evaluation of the economic damage (ED) because of the absence of pneumococcal vaccination as a leading risk factor for the development of community-acquired pneumonia (CAP) and acute exacerbations of а chronic obstructive pulmonary disease (COPD).

Materials and methods. The method of attributive statistics was used for the first time to assess the ED of the vaccination absence as an independent risk factor contributing to the development of CAP and COPD exacerbations in the Astrakhan region for the period of 2015–2019. To do this, at the beginning of the study based on the literature data, a relative risk of COPD complications associated with the absence of pneumococcal vaccination was determined. Using it as a risk factor, prevalence rates (a proportion of non-vaccinated patients with COPD), the population attributable risk (PAR) was calculated. Further, the annual economic damage (ED) from the development of CAP and COPD exacerbations was determined. To assess the cost-effectiveness of the COPD complications prevention, vaccination costs of newly registered patients were calculated and the ratio of these costs to the average annual ED was determined.

Results. A decrease in the non-vaccinated patients’ proportion corresponds to the decrease in the total ED from COPD complications: from 13.16 million rubles to 6.06 million rubles during the observation period. The calculations showed that due to the increase in the vaccinated patients’ proportion over a five-year observation period, the ED from the CAP development decreased by 2.1 times, from exacerbations of COPD – by 2.3 times. The vaccination costs of newly diagnosed COPD cases amounted to 0.63 million rubles. Thus, to prevent the annual ED of 3.24 million rubles, the sum for the state to spend, should be 5.2 times as small.

Conclusion. A study on the evaluation of the ED due to the risk factor (RF), the pneumococcal vaccination absence, showed that its elimination reduces the risk of acute COPD exacerbations and the development of CAP, as well the ED, as associated with them. Reducing the economic costs of the health care system with significantly lower vaccination costs, makes this preventive measure economically viable.

1. Kontsevaya AV, Mukaneeva DK, Myrzamatova AO, Balanova YuA, Khudyakov MB, Drapkina OM. Economic damage of risk factors associated with morbidity and mortality from major chronic non-communicable diseases in Russia in 2016. Cardiovascular Therapy and Prevention. 2020;19(1):48–55. DOI: 10.15829/1728-8800-2020-1-2396.

2. Iheanacho I, Zhang S, King D, Rizzo M, Ismaila AS. Economic Burden of Chronic Obstructive Pulmonary Disease (COPD): A Systematic Literature Review. Int J Chron Obstruct Pulmon Dis. 2020 Feb 26;15:439–60. DOI: 10.2147/COPD.S234942.

3. Lee J, Jung HM, Kim SK, Yoo KH, Jung KS, Lee SH, Rhee CK. Factors associated with chronic obstructive pulmonary disease exacerbation, based on big data analysis. Sci Rep. 2019 Apr 30;9(1):6679. DOI: 10.1038/s41598-019-43167-w.

4. Alqahtani JS, Njoku CM, Bereznicki B, Wimmer BC, Peterson GM, Kinsman L, Aldabayan YS, Alrajeh AM, Aldhahir AM, Mandal S, Hurst JR. Risk factors for all-cause hospital readmission following exacerbation of COPD: a systematic review and meta-analysis. Eur Respir Rev. 2020 Jun 3;29(156):190166. DOI: 10.1183/16000617.0166-2019.

5. Avdeev SN. Exacerbation of chronic obstructive pulmonary disease: a choice of antibacterial treatment. Pulmonologiya. 2014;(6):65–72. DOI: 10.18093/0869-0189-2014-0-6-65-72. Russian

6. Zhukova OV, Kononova SV, Konyshkina TM. Statistical relationship between smoking and frequent exacerbations of chronic obstructive pulmonary disease. Profilakticheskaya Meditsina. 2019;22(1):79–83. DOI: 10.17116/profmed20192201179. Russian

7. Postnikova LB, Klimkin PF, Boldina MV, Gudim AL, Kubysheva NI. Fatal severe community-acquired pneumonia: risk factors, clinical characteristics and medical errors of hospital patients. Terapevticheskii arkhiv. 2020; 92(3):42–9. DOI: 10.26442/00403660.2020.03.000538. Russian

8. Myint PK, Lowe D, Stone RA, Buckingham RJ, Roberts CM. U.K. National COPD Resources and Outcomes Project 2008: patients with chronic obstructive pulmonary disease exacerbations who present with radiological pneumonia have worse outcome compared to those with non-pneumonic chronic obstructive pulmonary disease exacerbations. Respiration. 2011;82(4):320–7. DOI: 10.1159/000327203.

9. Matanock A, Lee G, Gierke R, Kobayashi M, Leidner A, Pilishvili T. Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥ 65 Years: Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2019;68:1069–75. DOI: 10.15585/mmwr.mm6846a5.

10. Reinert R, Taysi B. Effectiveness of the 13-valent pneumococcal conjugate vaccine: emerging data from invasive pneumococcal disease, pneumonia, acute otitis media and nasopharyngeal carriage. Pediatric pharmacology. 2012;9(3):8–11. DOI: 10.15690/pf.v9i3.315.

11. Kostinov MP, Ryzhov AA, Magarshak OO, Zhirova SN, Protasov AD, Erofeev IuV, Migunova OV, Tolokonnikova IN, Liverko EV. The clinical aspects of efficiency of the prevention of pneumococcal infection with vaccines in chronic obstructive pulmonary disease patients living in the West Siberian Region. Ter Arkh. 2014;86(3):28–33. Russian

12. Halpin DM, Miravitlles M, Metzdorf N, Celli B. Impact and prevention of severe exacerbations of COPD: a review of the evidence. Int J Chron Obstruct Pulmon Dis. 2017 Oct 5;12:2891–908. DOI: 10.2147/COPD.S139470.

13. Kostinov AM, Kostinov MP, Mashilov CV. Antagonism between pneumococcal vaccines and COVID-19. Meditsinskiy sovet = Medical Council. 2020;(17):66–73. DOI: 10.21518/2079-701X-2020-17-66-73. Russian

14. Zaripova AZ, Bayazitova LT, Tyupkina OF, Chazova TA, Tyurin YA, Isaeva GSh, Pokrovskaya EM. Phenotypic and genotypic properties of Streptococcus pneumoniae in case of bacteria carrying. Practical Medicine. 2018; 16(9): 106–12. Russian

15. Protasov A, Kostinov M, Zhestkov A. Microbiological effect of anti-pneumococcal vaccination in COPD patients. 10th Intern Symposium On Pneumococci and Pneumococcal Diseases. 2016: 26–30.

16. Protasov AD, Kostinov MP, Zhestkov AV, Shteiner ML, Magarshak OO, Kostinova TA, Ryzhov AA, Pakhomov DV, Blagovidov DA, Panina MI. [Choice of optimal vaccination tactics against pneumococcal infection from immunological and clinical standpoints in patients with chronic obstructive pulmonary disease]. Ter Arkh. 2016;88(5):62–9. Russian. DOI: 10.17116/terarkh201688562-69.

17. Ignatova GL, Avdeev SN, Antonov VN. Comparative effectiveness of pneumococcal vaccination with PPV23 and PCV13 in COPD patients over a 5-year follow-up cohort study. Sci Rep. 2021;11: 15948. DOI: 10.1038/s41598-021-95129-w.

18. Artyukhov IP, Shulmin AV, Dobretsova EA, Arshukova IL. Ocenka mediko-demograficheskih poter’ i ekonomicheskih zatrat, obuslovlennyh hronicheskoj obstruktivnoj bolezn’yu legkih (na primere Krasnoyarskogo kraya) [Assessment of medical and demographic losses and economic costs caused by chronic obstructive pulmonary disease (on the example of the Krasnoyarsk Territory)]. Healthcare of the Russian Federation. 2015;59(5):32–7. Russian

19. Rycroft CE, Heyes A, Lanza L, Becker K. Epidemiology of chronic obstructive pulmonary disease: a literature review. Int J Chron Obstruct Pulmon Dis. 2012;7:457–94. DOI: 10.2147/COPD.S32330.

20. Vinnikov D, Rybina T, Strizhakov L, Babanov S, Mukatova I. Occupational Burden of Chronic Obstructive Pulmonary Disease in the Commonwealth of Independent States: Systematic Review and Meta-Analysis. Front Med (Lausanne). 2021 Jan 18;7:614827. DOI: 10.3389/fmed.2020.614827.

21. Smirnova MI, Antipushina DN, Kurekhyan AS. Chronic obstructive pulmonary disease and COVID-19: data by summer 2020, approaches to health care and prevention. Profilakticheskaya Meditsina. 2020;23(8):37–44. DOI: 10.17116/profmed20202308137. Russian

22. Dobbs R, Sawers C, Thompson F, Manyika J, Woetzel JR, Child P, McKenna S, Spatharou A. Overcoming obesity: An initial economic analysis. Executive summary. Discussion paper, 2014. Available from: http://www.mckinsey.com/mgi.

23. Zhukova OV, Khokhlov AL, Zhukova OV, Khokhlov AL. IGKS-terapiya kak faktor riska razvitiya vnebol’nichnoj pnevmonii u pacientov s hronicheskoj obstruktivnoj bolezn’yu legkih [Inhaled corticosteroid therapy as a risk factor for the development of community-acquired pnumonia in patients with chronic obstructive pulmonary disease]. Medicinal Bulletin. 2021; 15(3(83):28–35. Russian

24. Shulmin AV, Kozlov VV, Kutumova ОY, Dobretsova EA, Arshukova IL. Assessment of the costs of the health care system at the krasnoyarsk territory, due to diseases associated with tobacco smoking. Siberian Medical Review. 2013;4:74–7. Russian

25. Walters JA, Tang JN, Poole P, Wood-Baker R. Pneumococcal vaccines for preventing pneumonia in chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2017 Jan 24;1(1):CD001390. DOI: 10.1002/14651858.CD001390.pub4.

26. Figueira-Gonçalves JM, Bethencourt-Martín N, Pérez-Méndez LI, Díaz-Pérez D, Guzmán-Sáenz C, Viña-Manrique P, Pedrero-García AJ. Impact of 13-valent pneumococal conjugate polysaccharide vaccination in exacerbations rate of COPD patients with moderate to severe obstruction. Rev Esp Quimioter. 2017 Aug;30(4):269–75. English, Spanish.

27. Jgnatova GL, Antonov VN. Analysis of compliance dynamics in patients with chronic obstructive pulmonary disease on the background of vaccination against pneumococcal infection. Terapevticheskii arkhiv. 2018; 90(3): 47–52. DOI: 10.26442/terarkh201890347-52. Russian

28. Fekete M, Pako J, Nemeth AN, Tarantini S, Varga JT. Prevalence of influenza and pneumococcal vaccination in chronic obstructive pulmonary disease patients in association with the occurrence of acute exacerbations. J Thorac Dis. 2020 Aug;12(8):4233–42. DOI: 10.21037/jtd-20-814.

29. Protasov AD, Zhestkov AV, Kostinov MP, Shteiner ML, Tezikov IuV, Lipatov IS, Yastrebova NE, Kostinova AM, Ryzhov AA, Polishchuk VB. Analysis of the effectiveness and long-term results of formation of adaptive immunity in the use of various medications and vaccination schemes against pneumococcal infection in patients with chronic obstructive pulmonary disease. Terapevticheskii Arkhiv. 2017;89(12):165–74. DOI: 10.17116/terarkh20178912165-174. Russian

30. Ignatova GL, Antonov VN. Efficacy analysis of five-year experience of vaccination with conjugate pneumococcal vaccine in patients with chronic obstructive pulmonary disease. Pulmonologiya. 2018;28(2):185–92. DOI: 10.18093/0869-0189-2018-28-2-185-192. Russian

31. Ignatova GL, Antonov VN, Rodionova OV. The effectiveness of using the conjugated pneumococcal vaccine in patients with chronic obstructive pulmonary disease for 3 years. Consilium Medicum. 2016; 3: 42–6. Russian

32. Antonov VN. Vaccinal effect on early and late results in patients with chronic obstructive pulmonary disease. Modern problems of science and education. 2016;4:45. Russian

33. Krysanova VS, Zhuravleva MV, Dralova OV, Rogacheva OA, Kameneva TR. The problem of obesity and overweight in the russian federation and its pharmacoeconomic assessment. Almanac of Clinical Medicine. 2015; 1(1): 36–41. DOI: 10.18786/2072-0505-2015-1-36-41.

34. Askari M, Namayandeh SM. The Difference between the Population Attributable Risk (PAR) and the Potentioal Impact Fraction (PIF). Iran J Public Health. 2020 Oct;49(10):2018-2019. DOI: 10.18502/ijph.v49i10.4713.

35. Orlova EA, Umerova AR, Dorfman IP, Orlov MA, Abdullaev MA. Еstimation of socio-economic burden of chronic obstructive pulmonary disease for a 5-year period: a regional aspect. Pharmacy & Pharmacology. 2021;9(2):130–8. DOI: 10.19163/2307-9266-2021-9-2-130-138.

36. Orlova EA, Dorfman IP, Orlov MA, Abdullaev MA. Pharmacoeconomic evaluation of anti-pneumococcal vaccination in risk groups for the prevention of community-acquired pneumonia among adults in the Astrakhan region. Pharmacy & Pharmacology. 2020;8(6):436–45. DOI: 10.19163/2307-9266-2020-8-6-436-445.

37. Zhukova OV, Konyshkina TM, Kononova SV. The concept of risk factors in assessing the impact of smoking on an exacerbation of chronic obstructive pulmonary disease. Terapevticheskii arkhiv. 2015;87(3):23–6. Russian

38. Brown KF, Rumgay H, Dunlop C, Ryan M, Quartly F, Cox A, Deas A, Elliss-Brookes L, Gavin A, Hounsome L, Huws D, Ormiston-Smith N, Shelton J, White C, Parkin DM. The fraction of cancer attributable to modifiable risk factors in England, Wales, Scotland, Northern Ireland, and the United Kingdom in 2015. Br J Cancer. 2018 Apr;118(8):1130–41. DOI: 10.1038/s41416-018-0029-6.

39. Khalid F, Wang W, Mannino D, Diaz AA. Prevalence and Population Attributable Risk for Early Chronic Obstructive Pulmonary Disease in U.S. Hispanic/Latino Individuals. Ann Am Thorac Soc. 2022 Mar;19(3):363–71. DOI: 10.1513/AnnalsATS.202103-253OC.