Abstract
BackgroundCommunity-acquired pneumonia (CAP) is one of the most common acute infections associated with a substantial clinical and economic burden. There have been few studies assessing incidence rate, duration of hospitalization, and costs of hospitalized CAP by age and care-setting. MethodsA retrospective study was conducted using a nationwide Dutch database containing healthcare claims data of 16.7 million inhabitants. Patients with at least one claim with a discharge diagnosis of CAP between January 2008 and December 2011 were selected. The main outcome measures considered were the incidence rate, duration of hospitalization, and the direct costs of hospitalized CAP stratified by age and care-setting. ResultsIn total, 195,372 CAP cases were included in the analysis resulting in an average incidence of 295 per 100,000 population per year. Sixty-three percent (123,357) of the included patients were hospitalized for 1 or more nights, of which 5.9% (n=7241) spent at least one night in the Intensive Care Unit (ICU). Overall, these 123,357 patients spent 824,985 days in the hospital of which 48,324 were spent on the ICU. The mean duration of hospitalization of ICU patients and general ward patients was 15.2 days and 6.2 days, respectively. The total costs related to all 195,372 CAP episodes during these 4 years were €711 million, with the majority (76%) occurring among those aged 50 years and older. Median (and mean) costs were dependent on age and type of care with costs ranging from €344 (€482) per episode for 0–9 year olds treated in the outpatient hospital setting up to €10,284 (€16,374) per episode for 50–64 year olds admitted to the ICU. ConclusionThere is a large variation in terms of incidence, disease burden and costs across different age groups and the treatment setting. Effective interventions, targeted at older adults, to prevent pneumonia could reduce the (financial) burden due to pneumonia.
Highlights
Community-acquired pneumonia (CAP) is one of the most common acute infections necessitating hospitalization resulting in a considerable clinical and economic burden [1,2]
It was previously shown that both the incidence and CAP related costs are important drivers of the cost-effectiveness of pneumococcal vaccination programs targeting adults [9,10]. Accurate estimates of these parameters are crucial to estimate the cost-effectiveness of such programs especially that the results of the CAPiTA trial have shown that the 13-valent polysaccharide conjugate vaccine (PCV13) appeared effective in preventing vaccine-type pneumococcal, bacteremic, and nonbacteremic community-acquired pneumonia and vaccine-type invasive pneumococcal disease in adults aged 65 years and older [11]. To address this gap in the literature, the present study evaluated the incidence rate, the duration of hospitalizations and the direct hospitalization cost of CAP stratified by age and setting of care using a nationwide database covering the entire population of the Netherland
The highest incidence rate was found for treatment episodes in the general ward (176 per 100,000 inhabitants per year), followed by those treated in the outpatient setting (109 per 100,000 inhabitants per year) and in the Intensive Care Unit (ICU) (11 per 100,000 inhabitants per year)
Summary
Community-acquired pneumonia (CAP) is one of the most common acute infections necessitating hospitalization resulting in a considerable clinical and economic burden [1,2]. Accurate estimates of these parameters are crucial to estimate the cost-effectiveness of such programs especially that the results of the CAPiTA trial have shown that the 13-valent polysaccharide conjugate vaccine (PCV13) appeared effective in preventing vaccine-type pneumococcal, bacteremic, and nonbacteremic community-acquired pneumonia and vaccine-type invasive pneumococcal disease in adults aged 65 years and older [11] To address this gap in the literature, the present study evaluated the incidence rate, the duration of hospitalizations and the direct hospitalization cost of CAP stratified by age and setting of care using a nationwide database covering the entire population of the Netherland. Effective interventions, targeted at older adults, to prevent pneumonia could reduce the (financial) burden due to pneumonia
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