# Treatment costs of long-term invasive meningococcal disease sequelae: A literature review and Delphi study in Brazil

## TL;DR

This study estimates the high costs of long-term complications from meningococcal disease in Brazil, highlighting the need for healthcare and social support.

## Contribution

The study provides novel cost estimates for IMD sequelae in Brazil using a Delphi survey and microcosting approach.

## Key findings

- Amputations had the highest treatment costs due to hospitalization and therapy.
- Caregivers lost significant workdays due to IMD sequelae, especially for multiple limb amputations.
- Speech therapy and psychologist sessions were most needed for hearing loss and mental health disorders.

## Abstract

•Significant costs varying by sequelae type, care level, and medical procedures.•Delphi survey in Brazil: consensus on high resource use for IMD sequelae, especially in first year.•Highest costs for amputations with hospitalization, medical care, and therapy.•Findings aid in understanding patient & family needs, from healthcare to income loss.

Significant costs varying by sequelae type, care level, and medical procedures.

Delphi survey in Brazil: consensus on high resource use for IMD sequelae, especially in first year.

Highest costs for amputations with hospitalization, medical care, and therapy.

Findings aid in understanding patient & family needs, from healthcare to income loss.

This study describes and estimates the social and economic impact of Invasive Meningococcal Disease (IMD) sequelae globally and in Brazil. An integrative review was conducted to identify IMD sequelae costs estimates worldwide. The evidence identified supported the development of a Delphi survey to estimate medical Resource Use (RU) and caregiver productivity loss during the first Year (Y1) of IMD and the Subsequent Year (SY) in Brazil. Treatment costs of long-term IMD sequelae were estimated through microcosting approach using Brazilian cost reference tables and taking into account the Delphi survey estimates. The review included eight studies from high-income countries. Mean costs of IMD sequelae in high-income countries varied substantially by type of sequelae in Y1 (hearing loss $14,511; amputation $144,087), type of care over a lifetime horizon (outpatient $28,498; inpatient $67,038), and medical procedure over a lifetime horizon (shunt revision $22,794; prosthesis $508,735). The Delphi survey indicated that medical RU was significantly higher in Y1 versus SY. Resource use was highest for patients with multiple limb amputations. In addition, the highest number of outpatient visits (32) were required for patients with skin scars; speech therapy (72) for hearing loss; and the most psychologist sessions (116) for mental health disorders in Y1. Similarly, estimated treatment costs were highest for patients with multiple limb amputations ($4,139.70 in Y1 and $1,874.39 for SY), followed by single limb amputation ($2,803.24 in Y1 and $902.73 for SY) and skin scarring ($2,307.69 in Y1 and $816.19 for SY). All sequelae resulted in multiple workdays lost for caregivers, ranging from 33 (skin scarring) to 85 (multiple limbs amputation) during the first year of treatment. This study informs decision-makers on the healthcare, social and educational services, and social protection needs of patients with long-term sequelae in Brazil and globally.

Image, graphical abstract