Cost of Illness and Health-Related Quality of Life Among Adult Otitis Media Patients in Vietnam

Absztrakt (kivonat)

Background: Otitis media (OM) is considered one of the most prominent health concerns worldwide. There is a rise of evidence that illustrates the effects of otitis media regarding the decreased quality of life, symptom severity, reduced productivity, and absenteeism to work. It is well-studied in children's conditions, but there is a paucity of large-scale studies in adults. The cost of illness (COI) studies related to otitis media treatment in Vietnam also are sparse, have not been previously reported. Objective: This research aimed to investigate healthcare resource use and estimate the total financial burden of disease-related costs among the adult OM patients in Vietnam. This study also explored the associations between patients' characteristics and health-related quality of life among Vietnamese adult patients with OM. Methods: A cross-sectional study was conducted from 1st November 2020 to 31st January 2021 from three differently level hospitals (central, province, and district) in Thua Thien Hue province, Vietnam. Consecutive patients diagnosed with otitis media (an ICD-10 code of H65-H75) by the otolaryngologists from three participating hospitals. The administered interviews were conducted by the ear-nose-throat resident doctors and 4th-6th medical students using printed questionnaires, including participants' characteristics, health status, healthcare resource use, health-related quality of life, and well-being. The COI was estimated following a bottom-up, prevalence-based approach from the societal perspective by quantifying the total costs (the direct healthcare, the direct non-healthcare, and indirect costs) with the recall period from 7 days to 3 months. We applied one generic measure (the five-level EQ-5D: EQ-5D-5L) and one disease-specific measurement (the Chronic Otitis Media Outcome Test-15: COMOT-15) to assess the patient's quality of life. Our study was approved by the Institutional Ethical Review Committee of Hue University of Medicine and Pharmacy, Vietnam. All data were analyzed using the IBM SPSS Version 20.0, with the significance level was set at p < 0.05. Results: The annual expenditure per patient estimate was EUR 246.10 (95% CI 1,319.0 - 1,831.2) for the total 172 patients, which accounted for approximately 50% (95% CI 37, 52) of the Vietnamese gross domestic product per capita in 2020. That includes EUR 392.3, EUR 156.2, and EUR 1018.6 for direct healthcare costs, direct non-healthcare costs, and indirect costs, respectively. Bootstrap analysis showed that factors such as chronic OM, being employed, a higher household disposable income, and lower EQ-5D-5L index scores statistically had higher total costs due to OM (p<0.05). Concerning the health-related quality of life, the means of the COMOT-15, the EQ-5D-5L, and the EQ Visual Analogue Scale were 21.4, 0.77, and 74.6, respectively. Also, OM patients with a higher educational level and greater ability to pay for medication had a better health-related quality of life (p<0.05). Conclusions: This first cost-of-illness study on OM in Vietnamese adult patients provides valuable information in many ways. The estimated costs are high and indirect cost is significant in Vietnam. It is necessary to disseminate streptococcus pneumonia vaccine-related information, including its benefits and proper guidance on possible side effects to target groups and the whole Vietnamese population to reduce the disease's economic impact.