Incidence and Cost of Pneumonia in Medicare Beneficiaries

Thomas, Cindy Parks; Ryan, Marian; Chapman, J. D.; Stason, William B.; Tompkins, Christopher P.; Suaya, José A.; Polsky, Daniel; Mannino, David M.; Shepard, Donald S.

doi:10.1378/chest.11-1160

Cited by 95 publications

(78 citation statements)

References 38 publications

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“…2 The introduction of 13-valent pneumococcal conjugate vaccine (PCV13) to the recommended schedule for children significantly reduced the all-cause pneumonia hospitalizations for children burden, while it remained high among older adults. 3 In 2014, the Advisory Committee on Immunization Practices (ACIP) voted to add a single dose of PCV13 to the existing recommendation of 23-valent pneumococcal polysaccharide vaccine (PPSV23) for all adults over the age of 65 years.…”

Section: Introductionmentioning

confidence: 99%

Incremental Cost-Effectiveness of 13-valent Pneumococcal Conjugate Vaccine for Adults Age 50 Years and Older in the United States

et al. 2016

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BACKGROUND:Recently released results from a randomized controlled trial have shown that 13-valent pneumococcal conjugate vaccine (PCV13) is efficacious against vaccine-type nonbacteremic pneumonia in adults. OBJECTIVE: We examined the incremental costeffectiveness of adding PCV13 to the Advisory Committee on Immunization Practices (ACIP) adult immunization schedule. METHODS:We used a probabilistic model following cohorts of 50-, 60-, or 65-year-olds. We used separate vaccination coverage and disease incidence data for healthy and highrisk adults. Incremental cost-effectiveness ratios were determined for each potential vaccination strategy. RESULTS: In the base case scenario, our model indicated that adding PCV13 at age 65 or replacing 23-valent pneumococcal polysaccharide vaccine (PPSV23) at age 65 with PCV13 provided more value for money than adding PCV13 at ages 50 or 60. After projections of six additional years of herd protection from the childhood immunization program were incorporated, we found adding PCV13 dominated replacing PPSV23. For a cohort of 65-yearolds in 2013, the cost of adding PCV13 at age 65 to the schedule was $62,065 per quality-adjusted life year (QALY) gained, which rose to $272,621 after 6 years of projected herd protection. CONCLUSION: The addition of one dose of PCV13 for adults appears to have a cost-effectiveness ratio comparable to other vaccination interventions in the short run, though anticipated herd protection from the childhood immunization program may dramatically increase the cost per QALY after only a few years.

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Section: Introductionmentioning

confidence: 99%

Incremental Cost-Effectiveness of 13-valent Pneumococcal Conjugate Vaccine for Adults Age 50 Years and Older in the United States

et al. 2016

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“…Each year, nearly 400,000 Americans ages 65 and older are hospitalized for pneumonia [1]. Pneumonia is the third most common cause of hospitalization among Americans 65–84 years old, and the second most common among those over age 85 [2].…”

Section: Introductionmentioning

confidence: 99%

Depression and risk of hospitalization for pneumonia in a cohort study of older Americans

Davydow

Hough

Zivin

et al. 2014

Journal of Psychosomatic Research

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Objective To determine if depression is independently associated with risk of hospitalization for pneumonia after adjusting for demographics, medical comorbidity, health-risk behaviors, baseline cognition and functional impairments. Methods This secondary analysis of prospectively collected data examined a population-based sample of 6,704 Health and Retirement Study (HRS) (1998–2008) participants > 50 years old who consented to have their interviews linked to their Medicare claims and were without a dementia diagnosis. The eight-item Center for Epidemiologic Studies Depression Scale and/or International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) depression diagnoses were used to identify baseline depression. ICD-9-CM diagnoses were used to identify hospitalizations for which the principal discharge diagnosis was for bacterial or viral pneumonia. The odds of hospitalization for pneumonia for participants with depression relative to those without depression were estimated using logistic regression models. Population attributable fractions were calculated to determine the extent that hospitalizations for pneumonia could be attributable to depression. Results After adjusting for demographic characteristics, clinical factors, and health-risk behaviors, depression was independently associated with increased odds of hospitalization for pneumonia (Odds Ratio [OR]: 1.28, 95% Confidence Interval [95%CI]: 1.08, 1.53). This association persisted after adjusting for baseline cognition and functional impairments (OR: 1.24, 95%CI: 1.03, 1.50). In this cohort, 6% (95%CI: 2%, 10%) of pneumonia hospitalizations pneumonia were potentially attributable to depression. Conclusion Depression is independently associated with increased odds of hospitalization for pneumonia. This study provides additional rationale for integrating mental health care into medical settings in order to improve outcomes for older adults.

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“…A cost analysis for pneumonia across studies is challenging due to differences in coding and data sources for the definition of pneumonia as well as the analytical methods used to calculate costs [1,5,13,14,15,16]. According to a US pneumonia burden study, the mean LOS per hospital admission was 7.6 days, with a mean cost of US $6,949 per person (1997 value) [5].…”

Section: Discussionmentioning

confidence: 99%

“…The overall annual hospital cost for CAP in elderly patients in the US is $4.4 billion to $4.8 billion [5,16]. A US pneumonia cost analysis of hospital-treated pneumonia as a primary diagnosis in the elderly population in 2010, reported a conservative estimate of > US $7 billion, or US $9,749 per person (2005 to 2007 value); this imposes a tremendous burden on the US healthcare system [14]. However, those studies relied on Medicare administrative claims for the cost analysis, and the subjects selected may not have provided the actual costs of care.…”

Section: Discussionmentioning

confidence: 99%

Disease burden of pneumonia in Korean adults aged over 50 years stratified by age and underlying diseases

Lee

Yoo

Kim

et al. 2014

Korean J Intern Med

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Background/AimsThis study was conducted to assess the disease burden of pneumonia according to age and presence of underlying diseases in patients admitted with community-acquired pneumonia (CAP).MethodsWe performed a retrospective, observational study and collected data targeting patients with CAP (≥ 50 years) from 11 hospitals. Disease burden was defined as total per-capita medical fee, severity (CURB-65), hospital length of stay (LOS), and mortality.ResultsOf the 693 enrolled subjects, elderly subjects (age, ≥ 65 years) had a higher mean CURB-65 score (1.56 vs. 0.25; p < 0.01) and higher mortality than nonelderly subjects (4.4% [n = 21] vs. 0.5% [n = 1]; p = 0.00). In addition, the total cost of pneumonia treatment was higher in elderly patients compared to in nonelderly patients (KRW 2,088,190 vs. US $1,701,386; p < 0.01). Those with an underlying disease had a higher CURB-65 score (1.26 vs. 0.68; p < 0.01), were much older (mean age, 71.24 years vs. 64.24 years; p < 0.01), and had a higher mortality rate than those without an underlying disease (3.5% [n = 20] vs. 1.7% [n = 2]; p = 0.56). Total per-capita medical fees were higher (KRW 2,074,520 vs. US $1,440,471; p < 0.01) and hospital LOS was longer (mean, 8.38 days vs. 6.42 days; p < 0.01) in patients with underlying diseases compared to those without.ConclusionsDue to the relatively high disease burden in Korea, particularly in the elderly and in those with an underlying disease, closer and more careful observation is needed to improve the outcomes of patients with CAP.

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Incidence and Cost of Pneumonia in Medicare Beneficiaries

Cited by 95 publications

References 38 publications

Incremental Cost-Effectiveness of 13-valent Pneumococcal Conjugate Vaccine for Adults Age 50 Years and Older in the United States

Incremental Cost-Effectiveness of 13-valent Pneumococcal Conjugate Vaccine for Adults Age 50 Years and Older in the United States

Depression and risk of hospitalization for pneumonia in a cohort study of older Americans

Disease burden of pneumonia in Korean adults aged over 50 years stratified by age and underlying diseases

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