Treatment Costs of Community-Acquired Pneumonia in an Employed Population

Community-acquired pneumonia (CAP) has a high incidence and involves an important consumption of healthcare resources. The present authors analysed the influence of comorbidity, initial severity and complications upon the direct costs associated with hospitalised CAP patients.Direct hospitalisation costs (room cost, treatment, laboratory and diagnostic tests) were assessed in a prospective, observational study of 271 patients admitted to a hospital ward due to CAP.The mean¡SD patient age was 70¡15 yrs. The mortality rate was 11.1%. Complications were found in 72.3% and comorbidities in 74.9%. The median (interquartile range) total cost was J1,683 (J1,291-2,471) and the component costs were: room cost J1,286 (J857-1,714); laboratory tests J212 (J171-272); treatment J187 (J114-304); and diagnostic procedures J58 (J29-122). Complications and higher Pneumonia Severity Index increased the costs, but age and comorbidity did not. A logistic regression analysis to predict high cost (.J1,683) showed that infectious (odds ratio 6.8, 95% confidence interval 1.3-36), digestive (5.9 (1.5-22.8)), pulmonary (2.6 (1.4-4.7)) and other complications (3.9 (1.8-8.4)) were independent risk factors, as were previous hospitalisation (2.3 (1.2-4.3)) and hypoalbuminaemia (2 (1.1-3.6)).Complications, hypoalbuminaemia and previous hospitalisation were the main determinants of high direct costs of hospitalisation due to community-acquired pneumonia. Neither age nor comorbidities were independently associated with cost.

Section: Discussionmentioning

confidence: 91%

Determinants of hospital costs in community-acquired pneumonia

Reyes¹,

Martínez²,

Valles³

et al. 2008

“…In recent studies, direct treatment costs of in-patient care were estimated to range from US$1,333 in Germany [8] and J1,683 in Spain [7] up to J2,550-J7,650 in the UK [15]. Even higher costs per CAP case are found in studies from the USA (US$5,249-US$10,227) [16,17], although the median LOS tended to be longer in Europe. This is interesting as our group previously identified LOS as one of the major contributors to direct treatment costs in German hospitals [8].…”

Section: Discussionmentioning

confidence: 99%

Treatment failure in pneumonia: impact of antibiotic treatment and cost analysis

Ott¹,

Hauptmeier²,

Ernen³

et al. 2011

The aim of this study was to investigate treatment failure (TF) in hospitalised community-acquired pneumonia (CAP) patients with regard to initial antibiotic treatment and economic impact.CAP patients were included in two open, prospective multicentre studies assessing the direct costs for in-patient treatment. Patients received treatment either with moxifloxacin (MFX) or a nonstandardised antibiotic therapy. Any change in antibiotic therapy after .72h of treatment to a broadened antibiotic spectrum was considered as TF.Overall, 1,236 patients (mean¡SD age 69.6¡16.8 yrs, 691 (55.9%) male) were included. TF occurred in 197 (15.9%) subjects and led to longer hospital stay (15.4¡7.3 days versus 9.8¡4.2 days; p,0.001) and increased median treatment costs (J2,206 versus J1,284; p,0.001). 596 (48.2%) patients received MFX and witnessed less TF (10.9% versus 20.6%; p,0.001). After controlling for confounders in multivariate analysis, adjusted risk of TF was clearly reduced in MFX as compared with b-lactam monotherapy (adjusted OR for MFX 0.43, 95% CI 0.27-0.68) and was more comparable with a b-lactam plus macrolide combination (BLM) (OR 0.68, 95% CI 0.38-1.21).In hospitalised CAP, TF is frequent and leads to prolonged hospital stay and increased treatment costs. Initial treatment with MFX or BLM is a possible strategy to prevent TF, and may thus reduce treatment costs.

“…Of these, ,10% require admission to an intensive care unit (ICU) [2]. The total case fatality rate for hospitalised patients is often 10-15% [3]. The costs of in-patient treatment are substantial and comprise the majority of the estimated $8.4 billion?yr -1 cost of treating CAP in the USA [4].…”

mentioning

confidence: 99%

Prognostic score systems and community-acquired bacteraemic pneumococcal pneumonia

Spindler

Örtqvist²

2006

The aim of this study was to evaluate the accuracy of three score systems: the pneumonia severity index (PSI); CURB-65 (confusion; urea .7 mM; respiratory rate o30 breaths?min -1 ; blood pressure ,90 mmHg systolic or f60 mmHg diastolic; aged o65 yrs old); and modified American Thoracic Society rule for predicting intensive care unit (ICU) need and mortality due to bacteraemic pneumococcal pneumonia. All adult patients (n5114) with invasive pneumococcal pneumonia at the Karolinska University Hospital, Sweden, 1999-2000, were included in the study. Severity scores were calculated and the independent prognostic importance of different variables was analysed by multiple regression analyses.PSI oIV, CURB-65 o2, and the presence of one major or more than one minor risk factor in mATS all had a high sensitivity, but somewhat lower specificity for predicting death and ICU need. The death rate was 12% (13 out of 114). Severity score and treatment in departments other than the Dept of Infectious Diseases were the only factors independently correlated to death. Patients treated in other departments more often had severe underlying illnesses and were more severely ill on admission. However, a significant difference in death rates remained after adjustment for severity between the two groups.In conclusion, all score systems were useful for predicting the need for intensive care unit treatment and death due to bacteremic pneumococcal pneumonia. The pneumonia severity index was the most sensitive, but CURB-65 was easier to use.