Bronchopulmonary dysplasia (BPD) is among the most severe chronic lung diseases and predominantly affects premature infants. There is a general understanding of BPD’s significant impact on the short-term outcomes however there is little evidence on long-term outcomes. Our study estimates the lifetime clinical outcomes, quality of life, and healthcare costs of BPD and associated complications. We developed a microsimulation model to estimate lifetime clinical and economic burden of BPD among extreme preterm infants (≤28 weeks gestational age at birth) and validated it against the best available Canadian data. We further estimate the cumulative incidence of major complications associated with BPD, differentiated by BPD severity and gestational age category. We find, on average, patients with BPD and resulting complications will incur over CAD$700,000 in lifetime health systems costs. We also find the average life expectancy of BPD patients to be moderately less than that of the general population and significant reductions in quality-adjusted life year due to major complications. Healthcare utilization and quality of life measures vary dramatically according to BPD severity, suggesting significant therapeutic headroom for interventions that can prevent or mitigate the effects of BPD for patients. Our study adds a significant expansion of existing evidence by presenting the lifetime burden of BPD based on key patient characteristics. Given the extreme cost burden at the earliest stage of life and lifetime negative impact on quality of life, there is larger headroom for investment in prevention and mitigation of severe BPD than is currently available.

中文翻译：

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支气管肺发育不良 (BPD) 和极端早产儿的终生患者结局和医疗保健利用：一项微观模拟研究

支气管肺发育不良（BPD）是最严重的慢性肺部疾病之一，主要影响早产儿。人们普遍认识到边缘性人格障碍对短期结果的重大影响，但很少有证据表明其对长期结果的影响。我们的研究估计了 BPD 及相关并发症的终生临床结果、生活质量和医疗费用。我们开发了一个微观模拟模型来估计极端早产儿（出生时胎龄≤28周）BPD的终生临床和经济负担，并根据加拿大现有的最佳数据对其进行了验证。我们进一步估计了与 BPD 相关的主要并发症的累积发生率，并根据 BPD 严重程度和胎龄类别进行区分。我们发现，平均而言，边缘性人格障碍患者及其并发症将在一生中承担超过 70 万加元的医疗系统费用。我们还发现 BPD 患者的平均预期寿命略低于普通人群，并且由于严重并发症，质量调整生命年显着缩短。根据 BPD 的严重程度，医疗保健利用率和生活质量指标存在显着差异，这表明可以预防或减轻 BPD 对患者影响的干预措施具有巨大的治疗空间。我们的研究根据关键患者特征提出了 BPD 的终生负担，从而显着扩展了现有证据。鉴于生命早期阶段的极端成本负担以及对生活质量的终生负面影响，预防和缓解严重边缘性人格障碍的投资空间比目前更大。