Abstract
BackgroundThe burden of disease due to S. pneumoniae (pneumococcus), particularly pneumonia, remains high despite the widespread use of vaccines. Drug resistant strains complicate clinical treatment and may increase costs. We estimated the annual burden and incremental costs attributable to antibiotic resistance in pneumococcal pneumonia.MethodsWe derived estimates of healthcare utilization and cost (in 2012 dollars) attributable to penicillin, erythromycin and fluoroquinolone resistance by taking the estimate of disease burden from a previously described decision tree model of pneumococcal pneumonia in the U.S. We analyzed model outputs assuming only the existence of susceptible strains and calculating the resulting differences in cost and utilization. We modeled the cost of resistance from delayed resolution of illness and the resulting additional health services.ResultsOur model estimated that non-susceptibility to penicillin, erythromycin and fluoroquinolones directly caused 32,398 additional outpatient visits and 19,336 hospitalizations for pneumococcal pneumonia. The incremental cost of antibiotic resistance was estimated to account for 4% ($91 million) of direct medical costs and 5% ($233 million) of total costs including work and productivity loss. Most of the incremental medical cost ($82 million) was related to hospitalizations resulting from erythromycin non-susceptibility. Among patients under age 18 years, erythromycin non-susceptibility was estimated to cause 17% of hospitalizations for pneumonia and $38 million in costs, or 39% of pneumococcal pneumonia costs attributable to resistance.ConclusionsWe estimate that antibiotic resistance in pneumococcal pneumonia leads to substantial healthcare utilization and cost, with more than one-third driven by macrolide resistance in children. With 5% of total pneumococcal costs directly attributable to resistance, strategies to reduce antibiotic resistance or improve antibiotic selection could lead to substantial savings.
Highlights
The burden of disease due to S. pneumoniae, pneumonia, remains high despite the widespread use of vaccines
Among the 36,850 invasive pneumococcal disease cases identified by Active Bacterial Core surveillance (ABCs) in 2011, 9% were caused by penicillin non-susceptible strains and 26% were caused by erythromycin non-susceptible strains [12]
We focused our analysis on pneumonia, as our prior study found that pneumococcal pneumonia accounted for 866,000 annual cases
Summary
The burden of disease due to S. pneumoniae (pneumococcus), pneumonia, remains high despite the widespread use of vaccines. Drug resistant strains complicate clinical treatment and may increase costs. We estimated the annual burden and incremental costs attributable to antibiotic resistance in pneumococcal pneumonia. Streptococcus pneumoniae (pneumococcus) causes a variety of clinical syndromes, including acute otitis media, pneumonia, and meningitis. A major concern for treatment of pneumococcal disease is the increasing frequency of antibiotic resistance [15]. These strains are primarily resistant to penicillin, macrolides and, to a lesser extent, fluoroquinolones [16]. The financial impact of antibiotic-resistant pneumococcus has not been evaluated and is likely to depend upon many factors including whether antibiotic treatment is concordant or discordant with the susceptibility profile of the infecting strain. Discordant treatment may result in delayed cure, multiple outpatient visits or hospitalization, and increases in morbidity, mortality and cost
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