Care pathways in invasive meningococcal disease: a retrospective analysis of the French national public health insurance database

ABSTRACT

Invasive meningococcal disease (IMD) carries a high burden in terms of mortality, long-term complications, and cost, which can be significantly reduced by vaccination. The objectives of this case–control study were to document the care pathways of patients with IMD before, during, and after hospitalization and to assess in-hospital complications and long-term sequelae. Cases consisted of all people hospitalized for IMD in France between 2012 and 2017. Controls were matched by age, gender, and district of residence. Data were extracted from the French national public health insurance database on demographics, hospitalizations, mortality and potential sequelae of IMD. Overall, 3,532 cases and 10,590 controls were assessed and followed up for 2.8 years (median). During hospitalization, 1,577 cases (44.6%) stayed in an intensive care unit, 1,238 (35.1%) required mechanical ventilation, and 43 (1.2%) underwent amputation; 293 cases (8.3%) died in hospital and a further 163 (4.6%) died following discharge; 823 cases (25.4% of survivors) presented ≥1 sequela and 298 (9.2%) presented multiple sequelae. The most frequently documented sequelae were epilepsy (N = 205; 5.8%), anxiety (N = 196; 5.5%), and severe neurological disorders (N = 193; 5.5%). All individual sequelae were significantly more frequent (p < .0001) in cases than controls. Hearing/visual impairment and communication problems were conditions that presented the highest risk for cases compared to controls (risk ratios >20 in all cases). In conclusion, this study highlights the importance of providing optimal medical care for patients with IMD, of minimizing the delay before hospitalization, and of effective prevention through comprehensive vaccination programs.

This study highlights

• Benefits of providing optimal medical care for IMD patients.

• Importance of minimising the delay before hospitalization.

• IMD remains challenging to diagnose, and vaccination is the most efficient way to prevent the disease and its complications.

KEYWORDS:

• Invasive meningococcal disease
• care pathways
• sequelae
• France
• health insurance database
• mortality

Acknowledgments

The authors would like to thank Kinga Meszaros (GSK, Belgium) for her participation in the scientific committee and involvement in the discussions and Valérie Grange (GSK, France) for her input during the development of the present manuscript. Joffrey Baneton (Intys Consulting c/o GSK) assisted as operational and project manager during the conduct of the study. Medical writing support was provided by Adam Doble (Foxymed, on behalf of GSK). The authors would also like to thank Business & Decision Life Sciences platform for editorial assistance and manuscript coordination on behalf of GSK. Lyes Derouiche (Business & Decision Life Sciences platform) coordinated manuscript development and editorial support.

Authors’ contribution

All authors participated in the design or implementation or analysis, and interpretation and development of this manuscript. All authors had full access to the data and gave final approval before submission.

Disclosure statement

CP, EB, GN, and VL-P are employed by the GSK group of companies. EB and GN hold shares in the GSK group of companies. CW-O received honoraria for lectures from the GSK group of companies and from AstraZeneca, MedImmune, Pfizer, Sanofi-Pasteur, Seqirus outside of the presented work. M-KT reported his institution received fees from the GSK group of companies for the work presented here and from the GSK group of companies, Pfizer and Sanofi-Pasteur for activities outside the presented work. M-KT reported a patent (630133) issued. SB and CE reported that their institution (CEMKA) received grants from the GSK group of companies to perform the study related to the present publication. All authors declare no other financial and non-financial relationships and activities.

Data availability statement

GSK makes available anonymized individual participant data and associated documents from interventional clinical studies that evaluate medicines upon approval of proposals submitted to www.clinicalstudydatarequest.com. To access data for other types of GSK sponsored research, for study documents without patient-level data and for clinical studies not listed, please submit an inquiry via the website.

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website at https://doi.org/10.1080/21645515.2021.2021764.

Additional information

Funding

GlaxoSmithKline Biologicals SA funded this study [GSK identifier: VxHO-00002] and was involved in all stages of study conduct, including analysis of the data. GlaxoSmithKline Biologicals SA also took charge of all costs associated with the development and publication of this manuscript.