Hospitalization costs for community-acquired pneumonia in Dutch elderly: an observational study

Abstract

BackgroundCommunity-acquired pneumonia (CAP) is one of the most common infections, especially in the elderly (≥65 years). The aim of this study was to quantify hospitalization costs for CAP in different age groups and in patients with different CAP risk profiles. Secondary objectives were to assess disease severity differences between placebo and vaccine receiving participants and identify cost driving factors of CAP in hospitalized elderly in the Netherlands.MethodsThis prospective cohort study of hospitalized CAP patients was executed in parallel to the Community Acquired Pneumonia Immunization Trial in Adults (CAPiTA). Within the CAPiTA, a cohort of 84,496 subjects aged ≥65, all suspected CAP-episodes presenting in one of the 58 participating hospitals between September 2008 and August 2013 were included. CAP was diagnosed on clinical and radiographical criteria. Invasive pneumococcal disease (IPD) and non-IPD-CAP episodes, regardless of the causing pathogen, were evaluated separately. Costs were calculated by multiplying recorded healthcare resources with Dutch unit cost prices for the year 2012. Multivariate regression analysis was performed to identify cost drivers.ResultsIn the sentinel hospitals 3225 suspected CAP and IPD episodes were included, of which 1933 were radiographically confirmed by chest X-ray. Analyses were conducted on confirmed CAP episodes only. Overall mean length of hospital stay was 12.1 days, the in-hospital mortality rate was 11.26 %, and mean costs were €8301 (95 % CI: €7760–€8999). When stratified in age-categories 65–74, 75–84 and ≥85, mean hospitalization costs were €8674, €8770 and €6197, respectively (p = 0.649). IPD-CAP and non-IPD-CAP mean hospitalization costs were €13,611 and €8081, respectively. Higher CURB-65 score and individuals at medium risk for developing pneumococcal disease were significantly associated with higher costs. Being male, lower age, previous admissions, lower risk, lower urbanity and higher socio-economic status were associated with lower costs.ConclusionsMean hospitalization costs of a CAP subject were €8301 and higher for IPD-CAP compared to non-IPD-CAP cases. Medium risk patients and higher CURB-65 scores were identified as cost driving factors.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1783-9) contains supplementary material, which is available to authorized users.

Incidence and costs of hospitalized adult influenza patients in The Netherlands: a retrospective observational study

“…The dataset consisted of age, gender, comorbidities (for details see supplemental file Table S1), influenza virus type (A/B), length of hospital stay (LOS) in days, intensive care unit (ICU) admission (yes/no, and length of ICU stay in days), droplet and contact isolation (yes/no), antibiotic therapy (yes/no), oseltamivir treatment (yes/no), and in-hospital mortality (yes/no, date) ( Table 1). Patients were stratified by age into four categories (18-44, 45-64, 65-74 and ≥ 75 years) and by risk of severe or complicated influenza illness into three groups (low, medium and high risk), based on the presence of comorbidities [10,20,21] (supplemental file Table S1). It was not feasible to collect data on influenza vaccination status, because it is not routinely documented in electronic patient records and a national influenza vaccination registry is not in place in The Netherlands.…”

“…Differences in case definition and study population are illustrated by Dutch studies, which focused mainly on community-acquired pneumonia (CAP) [9,10,45] and invasive pneumococcal disease [10] in, respectively, an adult [9,45] and elderly population [10]. Vissink et al [10] reported that mean hospitalization costs of an elderly CAP patient amounted to €8081. In comparison, we found arithmetic mean influenza-related hospitalization costs of €6183 (95% CI €4937-€7625) in the same age group.…”

“…In the United States (US), the average direct medical costs of seasonal influenza epidemics, based on 2003 US population demographics, were estimated at 10.4 billion dollar annually [7]. Dutch cost estimates are only available for total community-acquired pneumonia (CAP) hospitalized patients, but not further specified for influenza virus infections [8][9][10][11][12]. Moreover, incidence for influenza-like illness (ILI) is limited to patients visiting their general practitioner in primary care [13].…”

Erratum to: Hospitalization costs for community-acquired pneumonia in Dutch elderly: an observational study

“…In our discussion [1] we erroneously misclassified the study of Spoorenberg et al [2] as being a retrospective study using ICD records. Readers should know that the study of Spoorenberg et al [2] is similar to our study, a prospective cohort with confirmed CAP based on standardized diagnostic criteria.…”

Mortalidade e custos da pneumonia pneumocócica em adultos: um estudo transversal

“…(9) Hospitalizations of patients aged over 50 years have a greater economic impact, compared with hospitalizations of individuals aged 18 years or younger (average cost per episode of EUR 5,000 vs. EUR 2,750, respectively). (10,11) These rates of mortality and costs are higher in developing countries, and published data on PP in adults and its impact on health systems in these contexts are scarce. (11) The present study adds to the literature on the in-hospital mortality from PP and related direct and indirect costs, comparing elderly and younger adult patients in a university hospital in Brazil.…”