Trends in healthcare utilization and costs associated with pneumonia in the United States during 2008\u20132014

Sabine Tong,Caroline Amand,Moe H Kyaw,Alexia Kieffer

doi:10.1186/s12913-018-3529-4

Abstract

BackgroundPneumonia is the leading cause of morbidity and mortality worldwide. Pneumococcal conjugate vaccines have reduced the burden of pneumonia, but data on the current burden of pneumonia and its impact on the healthcare system are needed to inform the development and use of new vaccines and other preventive measures.MethodsWe retrospectively analyzed the frequency of pneumonia in the US during 2008–2014 using data from the MarketScan® Commercial Claims and Encounters database. Frequencies of healthcare utilization related to the index pneumonia episode were calculated using the annual number of enrolled person-years (PY) as the denominator and the number of individuals with pneumonia as the numerator. Pneumonia-associated costs were calculated as mean payment per episode during the 2 years from 2013 to 2014.ResultsThe overall annual healthcare utilization rate for pneumonia was 15.1 per 1000 PY and decreased slightly from 2008 to 2014 (from 15.4 to 13.5 per 1000 PY). Most pneumonia-related healthcare utilization was due to office/outpatient visits (10.3 per 1000 PY; 68.3%). Emergency department/urgent care visits (2.5 per 1000 PY; 16.9%) and hospitalizations (2.2 per 1000 PY; 14.8%) contributed less. Pneumonia-related healthcare utilization was highest in children < 5 years (rate per 1000 PY = 29.7 for < 1 year, 47.9 for 1 year, and 39.5 for 2–4 years) and adults > 65 years (45.0 per 1000 PY). The mean cost per pneumonia episode (95% confidence interval) was US$429.1 ($424.8–$433.4) for office/outpatient visits, $1126.9 ($1119.5–$1134.3) for emergency department/urgent care visits, and $10,962.5 ($10,822.8–$11,102.2) for hospitalization.ConclusionsThe burden of pneumonia on the US healthcare system remains substantial. The results presented here can help guide new vaccination strategies and other preventive interventions for reducing the remaining burden of pneumonia.

Highlights

Pneumonia is the leading cause of morbidity and mortality worldwide
We examined US insurance records to determine the annual frequency of pneumonia during 2008–2014 and the costs associated with index pneumonia events during the two most recent years (2013–2014)
Most pneumonia cases were reported in the South (36.8% overall) and North Central region (26.4% overall) (Table 1), the proportion decreased in both regions from 2008 to 2014 (Additional file 2: Table S2)

Summary

Introduction

Pneumococcal conjugate vaccines have reduced the burden of pneumonia, but data on the current burden of pneumonia and its impact on the healthcare system are needed to inform the development and use of new vaccines and other preventive measures. The impact of the 23-valent pneumococcal polysaccharide vaccine is uncertain [14], PCVs substantially decreased the incidence of pneumonia [15,16,17]; PCVs protect only against the 7 or 13 serotypes included and offer limited protection against all-cause pneumonia [7, 16]. To develop and implement new pneumococcal vaccines and other preventive measures, further data on the current burden of pneumonia and its impact on the healthcare system are needed. We examined US insurance records to determine the annual frequency of pneumonia during 2008–2014 and the costs associated with index pneumonia events during the two most recent years (2013–2014)

Methods

Results

Discussion

Conclusion