Skip to main content
Free access
Research Article
16 December 2019

The 1-year economic burden of community-acquired pneumonia (CAP) initially managed in the outpatient setting in the USA

Abstract

Aim: To assess the annual economic burden of community-acquired pneumonia (CAP) initially managed in the outpatient setting. Patients & methods: Patients with an outpatient diagnosis of CAP between January 2012 and December 2016 were identified from the IQVIA (Danbury, CT & Durham, NC, USA) Real-World Data Adjudicated Claims – US Database. All-cause and CAP-related healthcare resource utilization and costs were assessed over the 1-year follow-up. Generalized linear model examined adjusted total cost. Results: Among 256,916 patients with outpatient CAP, a tenth (10.6%) had ≥1 hospitalization and, of these, 18.7% had ≥1 CAP-related hospitalization. The mean total cost per patient was US$14,372; 10.9% was CAP-related and 26.1% was due to inpatient care. The adjusted mean total all-cause cost was US$13,788. Conclusion: Patients with outpatient CAP incurred a substantial annual economic burden.

Formats available

You can view the full content in the following formats:

References

Papers of special note have been highlighted as: • of interest; •• of considerable interest
1.
Hayes BH, Haberling DL, Kennedy JL, Varma JK, Fry AM, Vora NM. Burden of pneumonia-associated hospitalizations: United States, 2001–2014. Chest 153(2), 427–437 (2018).
2.
Murphy SL, Xu J, Kochanek KD, Arias E. Mortality in the united states, 2017. NCHS Data Brief (328), 1–8 (2018).
3.
Agency for Healthcare Research and Quality R, MD. Community-acquired pneumonia clinical decision support implementation toolkit (2018). http://www.ahrq.gov/professionals/quality-patient-safety/hais/tools/ambulatory-care/cap-toolkit.html
4.
Park H, Adeyemi AO, Rascati KL. Direct medical costs and utilization of health care services to treat pneumonia in the United States: an analysis of the 2007–2011 medical expenditure panel survey. Clin. Ther. 37(7), 1466–1476.e1 (2015).
• Retrospective analysis of Medical Expenditure Panel Survey data on pneumonia incidence, annual healthcare utilization and expenditures across five age groups.
5.
Weycker D, Farkouh RA, Strutton DR, Edelsberg J, Shea KM, Pelton SI. Rates and costs of invasive pneumococcal disease and pneumonia in persons with underlying medical conditions. BMC Health Serv. Res. 16(1), 182 (2016).
6.
Chang D, Bednarczyk RA, Becker ER et al. Trends in US hospitalizations and inpatient deaths from pneumonia and influenza, 1996–2011. Vaccine 34(4), 486–494 (2016).
7.
Broulette J, Yu H, Pyenson B, Iwasaki K, Sato R. The incidence rate and economic burden of community-acquired pneumonia in a working-age population. Am. Health Drug Benefits 6(8), 494 (2013).
•• Claims-based analysis of a commercially insured population that estimated incidence rate of community-acquired pneumonia (CAP), direct costs of CAP episodes and annual direct and indirect costs between cases and controls.
8.
Jain S, Self WH, Wunderink RG et al. Community-acquired pneumonia requiring hospitalization among U.S. adults. N. Engl. J. Med. 373(5), 415–427 (2015).
9.
Tansarli GS, Mylonakis E. Systematic review and meta-analysis of the efficacy of short-course antibiotic treatments for community-acquired pneumonia in adults. Antimicrob. Agents Chemother. 62(9), e00635-18 (2018).
10.
Mandell LA, Wunderink RG, Anzueto A et al. IDSA/ATS consensus guidelines on the management of community-acquired pneumonia in adults. Clin. Infect. Dis. 44(Suppl. 2), S27–S72 (2007).
• The most recent guidelines on the management of CAP from Infectious Diseases Society of America/American Thoracic Society.
11.
Bartlett JG, Dowell SF, Mandell LA, File TM Jr, Musher DM, Fine MJ. Practice guidelines for the management of community-acquired pneumonia in adults. Clin. Infect. Dis. 31(2), 347–382 (2000).
12.
Wunderink RG, Yin Y. Antibiotic resistance in community-acquired pneumonia pathogens. Seminars in respiratory and critical care medicine. Semin. Respir. Crit. Care Med. 37(6), 829–838 (2016).
13.
Peyrani P, Mandell L, Torres A, Tillotson GS. The burden of community-acquired bacterial pneumonia in the era of antibiotic resistance. Expert Rev. Respir. Med. 13(2), 139–152 (2019).
14.
Postma DF, van Werkhoven CH, Van Elden LJ et al. Antibiotic treatment strategies for community-acquired pneumonia in adults. N. Engl. J. Med. 372(14), 1312–1323 (2015).
15.
Pakhale S, Mulpuru S, Verheij TJ, Kochen MM, Rohde GG, Bjerre LM. Antibiotics for community-acquired pneumonia in adult outpatients. Cochrane Database Syst. Rev. (10), Cd002109 (2014).
16.
Llop CJ, Tuttle E, Tillotson GS, LaPlante K, File TM. Antibiotic treatment patterns, costs, and resource utilization among patients with community acquired pneumonia: a US cohort study. Hosp. Pract. (1995) 45(1), 1–8 (2017).
• Claims-based study evaluating adverse events, treatment patterns, resource use and costs among commercially insured adults with CAP treated with antibiotics in the inpatient or outpatient setting.
17.
Bonafede MM, Suaya JA, Wilson KL, Mannino DM, Polsky D. Incidence and cost of CAP in a large working-age population. Am. J. Manag. Care 18(7), 380–387 (2012).
•• Claims-based analysis of commercially insured adults that estimated incidence rates and quantified the excess direct and indirect costs of CAP among cases with CAP relative to matched controls without CAP.
18.
Yu H, Rubin J, Dunning S, Li S, Sato R. Clinical and economic burden of community‐acquired pneumonia in the Medicare fee‐for‐service population. J. Am. Geriatr. Soc. 60(11), 2137–2143 (2012).
19.
McLaughlin JM, Johnson MH, Kagan SA et al. Clinical and economic burden of community-acquired pneumonia in the Veterans Health Administration, 2011: a retrospective cohort study. Infection 43(6), 671–680 (2015).
20.
Sato R, Rey GG, Nelson S, Pinsky B. Community-acquired pneumonia episode costs by age and risk in commercially insured US adults aged≥ 50 years. Appl. Health Econ. Health Pol. 11(3), 251–258 (2013).
•• Claims-based analysis of commercially insured older adults evaluating the direct cost of inpatient and outpatient CAP episodes, stratified by age and risk profile.
21.
Romano PS, Roos LL, Jollis JG. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. J. Clin. Epidemiol. 46(10), 1075–1079 (1993).
22.
Rothberg MB, Haessler S, Lagu T et al. Outcomes of patients with healthcare-associated pneumonia: worse disease or sicker patients? Infect. Control Hosp. Epidemiol. 35(Suppl. 3), (03), S107–S115 (2014).
23.
Bornheimer R, Shea KM, Sato R, Weycker D, Pelton SI. Risk of exacerbation following pneumonia in adults with heart failure or chronic obstructive pulmonary disease. PLoS ONE 12(10), e0184877 (2017).
24.
Eurich DT, Marrie TJ, Minhas-Sandhu JK, Majumdar SR. Risk of heart failure after community acquired pneumonia: prospective controlled study with 10 years of follow-up. BMJ 356, j413 (2017).
25.
Lutfiyya MN, Henley E, Chang LF, Reyburn SW. Diagnosis and treatment of community-acquired pneumonia. Am. Fam. Physician 73(3), 442–450 (2006).
26.
Fine MJ, Pratt HM, Obrosky DS et al. Relation between length of hospital stay and costs of care for patients with community-acquired pneumonia. Am. J. Med. 109(5), 378–385 (2000).
27.
Zilberberg MD, Shorr AF. Epidemiology of healthcare-associated pneumonia (HCAP). Semin. Respir. Crit. Care Med. 30(1), 10–15 (2009).
28.
Liu HH. Safety profile of the fluoroquinolones: focus on levofloxacin. Drug Saf. 33(5), 353–369 (2010).
29.
U.S. Food and Drug Administration. Drug Safety Communication: FDA warns about increased risk of ruptures or tears in the aorta blood vessel with fluoroquinolone antibiotics in certain patients (2018). https://www.fda.gov/Drugs/DrugSafety/ucm628753.htm
30.
US Food and Drug Administration. FDA Drug Safety Communication: FDA advises restricting fluoroquinolone antibiotic use for certain uncomplicated infections; warns about disabling side effects that can occur together (2016). https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-advises-restricting-fluoroquinolone-antibiotic-use-certain
31.
European Medicines Agency. Disabling and potentially permanent side effects lead to suspension or restrictions of quinolone and fluoroquinolone antibiotics (2018). https://www.ema.europa.eu/en/documents/press-release/disabling-potentially-permanent-side-effects-lead-suspension-restrictions-quinolone-fluoroquinolone_en.pdf
32.
Thomas CP, Ryan M, Chapman JD et al. Incidence and cost of pneumonia in Medicare beneficiaries. Chest 142(4), 973–981 (2012).