Observed costs and health care use of children in a prospective cohort study on community-acquired pneumonia in Geneva, Switzerland

K Keitel,S Manzano,L Lacroix,A Gervaix,G Alcoba,A Galetto-Lacour

doi:10.4414/smw.2014.13925

Abstract

Despite various efforts to estimate cost-effectiveness of pneumococcal conjugate vaccines, only scarce information on the cost burden of paediatric community acquired pneumonia (CAP) exists. The objective of this study was to prospectively calculate direct and indirect costs associated with treatment of CAP from a society perspective in children between 2 months and 16 years of age seeking care at a tertiary hospital in Geneva, Switzerland between December 2008 and May 2010. This cost of illness study population comprised children aged from 2 months to 16 years of age seeking care for CAP at the University Children's Hospital Geneva from January 2008 through May 2010 (a subset of patients taken from a larger multicentre prospective cohort). Hospital-associated costs for episodes of pneumonia were computed according to the REKOLE® system. Non-hospital costs were estimated by parental interviews at baseline and follow-up on day 14. The overall cost for one episode of CAP was 11'258 CHF; 23'872 CHF for inpatient treatment and 1009 CHF for outpatient treatment. Severe pneumonia cases per World Health Organisation (WHO) definition used significantly more hospital resources than non-severe cases: 21'842 CHF versus 3'479 CHF (p <0.0001). Childhood CAP results in a significant medical cost burden that may have been underestimated in previous cost-effectiveness analyses of pneumococcal vaccine strategies.

Highlights

With an estimated 156 million new clinical cases per year, childhood community acquired pneumonia (CAP) remains a leading aetiology of child morbidity and mortality worldwide and creates a significant cost burden [1]
Childhood CAP results in a significant medical cost burden that may have been underestimated in previous cost-effectiveness analyses of pneumococcal vaccine strategies
Severe CAP episodes were identified per World Health Organisation (WHO) classification, that is, abnormal respiratory rate for age associated with the presence of ≥1 of the following: signs of respiratory distress, moderate to severe dehydration, or oxygen requirement

Summary

Introduction

With an estimated 156 million new clinical cases per year, childhood community acquired pneumonia (CAP) remains a leading aetiology of child morbidity and mortality worldwide and creates a significant cost burden [1]. Incidence rates in western countries, based on prospective population-based studies from the 1970s-1980s, are assumed to be around 20–40/1000 in children below 10 years of age [2]. Routine infant immunisation with 7-valent pneumococcal conjugate vaccine (PCV 7) has decreased rates of pneumonia admissions in young children both in the US and Europe [5–7]. National recommendations about pneumococcal vaccines have included assessments of cost effectiveness, And Immunisation strategies with PCV 7 have been studied in a large number of countries. The objective of this study was to calculate direct and indirect costs associated with treatment of CAP in children between 2 months and 16 years of age seeking care at a tertiary hospital in Geneva, Switzerland

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Discussion

Conclusion