Microbial aetiology, outcomes, and costs of hospitalisation for community-acquired pneumonia; an observational analysis

Abstract

BackgroundThe aim of this study was to investigate the clinical outcome and especially costs of hospitalisation for community-acquired pneumonia (CAP) in relation to microbial aetiology. This knowledge is indispensable to estimate cost-effectiveness of new strategies aiming to prevent and/or improve clinical outcome of CAP.MethodsWe performed our observational analysis in a cohort of 505 patients hospitalised with confirmed CAP between 2004 and 2010. Hospital administrative databases were extracted for all resource utilisation on a patient level. Resource items were grouped in seven categories: general ward nursing, nursing on ICU, clinical chemistry laboratory tests, microbiology exams, radiology exams, medication drugs, and other.linear regression analyses were conducted to identify variables predicting costs of hospitalisation for CAP.ResultsStreptococcus pneumoniae was the most identified causative pathogen (25%), followed by Coxiella burnetii (6%) and Haemophilus influenzae (5%). Overall median length of hospital stay was 8.5 days, in-hospital mortality rate was 4.8%.Total median hospital costs per patient were €3,899 (IQR 2,911-5,684). General ward nursing costs represented the largest share (57%), followed by nursing on the intensive care unit (16%) and diagnostic microbiological tests (9%). In multivariate regression analysis, class IV-V Pneumonia Severity Index (indicative for severe disease), Staphylococcus aureus, or Streptococcus pneumonia as causative pathogen, were independent cost driving factors. Coxiella burnetii was a cost-limiting factor.ConclusionsMedian costs of hospitalisation for CAP are almost €4,000 per patient. Nursing costs are the main cause of these costs.. Apart from prevention, low-cost interventions aimed at reducing length of hospital stay therefore will most likely be cost-effective.

Incidence, direct costs and duration of hospitalization of patients hospitalized with community acquired pneumonia: A nationwide retrospective claims database analysis

“…Our mean costs of (≈D 5000) for hospitalized adults on the general ward are very similar to a recent smaller prospective (≈D 4000) and retrospective (≈D 4900) studies performed in the Netherlands [21,22]. Similar to our study, a study performed in the USA also showed that while the mean length of hospital stay increased with age, the costs did not increase proportionally to the length of stay in the hospital [23].…”

“…Streptococcus pneumoniae is generally accepted to be the most common cause of CAP [28]. A recent Dutch study among 505 patients hospitalized with community-acquired pneumonia showed that in those cases in which a pathogen could be detected (n = 295) S. pneumoniae was causative pathogen in 42% of the cases [22]. Furthermore, data from the CAPiTA trial showed that 13% of the first episodes of community-acquired pneumonia were episodes caused by the 13 vaccine serotypes included in PCV13 [11].…”

Atypical pathogen infection in community-acquired pneumonia

“…Two studies in Netherlands found that Streptococcus pneumoniae was the main cause of CAP, with 25% and 22% of detectable rates. But there were inconsistent detectable rates between the two studies in terms of atypical pathogens (9% and 20%) (26,27). Whereas a study in the north of Israel shows the detectable rate of atypical pathogens.…”

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.…”