Comorbidities as a driver of the excess costs of community-acquired pneumonia in U.S. commercially-insured working age adults

Polsky, Daniel; Bonafede, Machaon; Suaya, José A.

doi:10.1186/1472-6963-12-379

Cited by 35 publications

(46 citation statements)

References 24 publications

(23 reference statements)

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“…Pneumonia was found to be associated with both direct and indirect costs. Some studies have demonstrated that pneumonia increases total direct costs by 1.9–2.5 times for outpatients and by 3.39–4.72 times for hospitalized patients 15,32. In this study, costs were 1.6 times higher in patients with pneumonia compared to those without pneumonia.…”

Section: Discussionsupporting

confidence: 42%

“…Previous studies have demonstrated a direct relationship between the yearly costs of COPD and the number of comorbid diseases 15,23,31. Perera et al23 assessed the factors responsible for increasing costs for patients hospitalized due to exacerbation and reported a significant relation between increased costs and comorbidities, such as acute myocardial infarction, congestive heart failure, cerebrovascular disease, lung cancer, arrhythmia, pulmonary thromboembolism, and low body weight.…”

Section: Discussionmentioning

confidence: 99%

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Clinical factors and comorbidities affecting the cost of hospital-treated COPD

Deniz

Şengül

Aydemir³

et al. 2016

COPD

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PurposeWe aimed to assess the effects of comorbidities on COPD costs and to investigate the relationship between comorbidities and clinical variables.Patients and methodsAll patients hospitalized with a diagnosis of COPD exacerbation between January 1, 2014, and December 31, 2014, at all state hospitals of Aydın province, a city located in the western part of Turkey, were included in this study. The costs examined in the study pertained to medications, laboratory tests, hospital stays, and other treatment-related factors, such as consumption of materials, doctor visits, and consultation fees.ResultsA total of 3,095 patients with 5,237 exacerbations (mean age, 71.9±10.5 years; 2,434 males and 661 females) were evaluated. For 880 of the patients (28.9%), or 3,852 of the exacerbations (73.1%), at least one comorbid disease was recorded. The mean cost of each exacerbation was $808.5±1,586, including $325.1±879.9 (40.7%) for hospital stays, $223.1±1,300.9 (27.6%) for medications, $46.3±49.6 (0.9%) for laboratory expenditures, and $214±1,068 (26.5%) for other treatment-related factors, such as consumption of materials, doctor visits, and consultation fees. The cost of each exacerbation was $1,014.9 in patients with at least one comorbidity, whereas it was $233.6 in patients without comorbidity (P<0.001). Age >65 years, female gender, hospitalization in an intensive care unit, invasive or noninvasive mechanical ventilation, and a long duration of hospitalization were all found to be significant factors in increasing total costs during the exacerbations requiring hospitalization (P<0.05 for all).ConclusionComorbidities have an important role in the total costs of acute exacerbations of COPD. Strategies for the prevention, diagnosis, and effective management of comorbidities would decrease the overall financial burden associated with acute exacerbations of COPD.

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Section: Discussionsupporting

confidence: 42%

Section: Discussionmentioning

confidence: 99%

Clinical factors and comorbidities affecting the cost of hospital-treated COPD

Deniz

Şengül

Aydemir³

et al. 2016

COPD

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“…In a study by Polsky et al,11 patients with COPD had annual total costs of $30,781 and incremental costs of $17,039 compared to patients without COPD for total medical expenses. These costs are slightly less than our estimation of $36,825 for total medical costs.…”

Section: Discussionmentioning

confidence: 99%

“…In a study of community-acquired pneumonia in working-age adults, pneumonia associated with COPD resulted in mean excess annualized medical costs (hospitalization, outpatient, pharmacy) of US$17,039 and an excess annualized productivity loss (absenteeism, short-term disability) of $6,454 versus (vs) matched controls without pneumonia 11. These excess medical costs were almost two times greater for patients with COPD and pneumonia than for patients with pneumonia without any comorbidities.…”

Section: Introductionmentioning

confidence: 99%

Costs and health care resource utilization among chronic obstructive pulmonary disease patients with newly acquired pneumonia

Lin¹,

Li²,

Tian³

et al. 2014

CEOR

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BackgroundPatients with chronic obstructive pulmonary disease (COPD) are at increased risk for lung infections and other pathologies (eg, pneumonia); however, few studies have evaluated the impact of pneumonia on health care resource utilization and costs in this population. The purpose of this study was to estimate health care resource utilization and costs among COPD patients with newly acquired pneumonia compared to those without pneumonia.MethodsA retrospective claims analysis using Truven MarketScan® Commercial and Medicare databases was conducted. COPD patients with and without newly acquired pneumonia diagnosed between January 1, 2004 and September 30, 2011 were identified. Propensity score matching was used to create a 1:1 matched cohort. Patient demographics, comorbidities (measured by Charlson Comorbidity Index), and medication use were evaluated before and after matching. Health care resource utilization (ie, hospitalizations, emergency room [ER] and outpatient visits), and associated health care costs were assessed during the 12-month follow-up. Logistic regression was conducted to evaluate the risk of hospitalization and ER visits, and gamma regression models and two-part models compared health care costs between groups after matching.ResultsIn the baseline cohort (N=467,578), patients with newly acquired pneumonia were older (mean age: 70 versus [vs] 63 years) and had higher Charlson Comorbidity Index scores (3.3 vs 2.6) than patients without pneumonia. After propensity score matching, the pneumonia cohort was nine times more likely to have a hospitalization (odds ratio; 95% confidence intervals [CI] =9.2; 8.9, 9.4) and four times more likely to have an ER visit (odds ratio; 95% CI =4.4; 4.3, 4.5) over the 12-month follow-up period compared to the control cohort. The estimated 12-month mean hospitalization costs ($14,353 [95% CI: $14,037–$14,690]), outpatient costs ($6,891 [95% CI: $6,706–$7,070]), and prescription drug costs ($1,104 [95% CI: $1,054–$1,142]) were higher in the pneumonia cohort than in the control cohort.ConclusionThis study demonstrated elevated health care resource use and costs in patients with COPD after acquiring pneumonia compared to those without pneumonia.

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“…Even in a younger, working-age (18-64 years) population, CAP represents a major economic burden, with both direct medical costs and loss of productivity resulting in an estimated national cost of $10.6 billion [9•]. CAP patients with CHF, COPD, and diabetes have substantially higher healthcare costs than patients with no comorbidities [3]. This knowledge should help identify target groups for a more robust approach to preventing CAP.…”

Section: Introductionmentioning

confidence: 99%

Management of community-acquired pneumonia

Ehsan¹,

Metersky

2013

Curr Respir Care Rep

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This article summarizes recent literature related to community-acquired pneumonia (CAP), which continues to represent one of the most common causes of morbidity and mortality throughout the world, especially in the elderly. The impact is even more striking if we take healthcare costs into account. Patients with CAP usually have other comorbidities which not only increase mortality in this group but also add further to its economic burden. Patients with COPD, preexisting cardiac disease, and diabetes are particularly at higher risk for developing more severe pneumonia. New diagnostic modalities, including ultrasonography, are being used more commonly in clinical practice. Procalcitonin levels can be used to identify bacterial pneumonia and to de-escalate antibiotic therapy, resulting in fewer days on antibiotics. Other biomarkers have been used in studies to stratify patients by risk. Guideline-concordant regimens including atypical coverage, and macrolides in particular, appear to provide benefit. More recent data suggest the need for careful screening of patients for cardiovascular risk factors prior to initiating macrolides and fluoroquinolones.

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Comorbidities as a driver of the excess costs of community-acquired pneumonia in U.S. commercially-insured working age adults

Cited by 35 publications

References 24 publications

Clinical factors and comorbidities affecting the cost of hospital-treated COPD

Clinical factors and comorbidities affecting the cost of hospital-treated COPD

Costs and health care resource utilization among chronic obstructive pulmonary disease patients with newly acquired pneumonia

Management of community-acquired pneumonia

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