Clinical and Economic Burden of Community-Acquired Pneumonia in the Medicare Fee-for-Service Population

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 60; no. 11; pp. 2137 - 2143
• Main Authors: Yu, Holly, Rubin, Jaime, Dunning, Stephan, Li, Suying, Sato, Reiko
• Format: Journal Article
• Language: English
• Published: Hoboken, NJ Blackwell Publishing Ltd 01.11.2012; Wiley-Blackwell; Wiley Subscription Services, Inc
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; case-fatality; Community-Acquired Infections - economics; Cost of Illness; Fee-for-Service Plans - economics; Female; General aspects; Health care expenditures; Humans; incidence; Male; Medical sciences; Medicare; Medicare - economics; Middle Aged; Miscellaneous; older adults; Pneumonia; Pneumonia - economics; Pneumonia - epidemiology; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; United States; Young Adult; United States; North America; America; Human; Lung disease; Health insurance; Costs; Pneumonia; Poverty; Respiratory disease; Mortality; Incidence; case-fatality; Gerontology; Community acquired infection; Health economy; older adults; Death; Population; Economic aspect; Fee for service; Elderly; Public health; Geriatrics
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/j.1532-5415.2012.04208.x

Objectives To estimate current community‐acquired pneumonia (CAP) incidence and its associated economic burden in the Medicare fee‐for‐service (FFS) population. Design Retrospective. Setting The 2007/08 Medicare Standard Analytic Files, a nationally representative random sample (5%) of Medicare beneficiaries enrolled in the FFS program. Participants Residents of one of the 50 U.S. states or the District of Columbia aged 18 and older on July 1, 2007, with continuous Part A and Part B coverage during calendar year 2007. Measurements Incidence, episode length, mortality, and costs were assessed. All‐cause costs were assessed using three methodologies: costs during the episode, and incremental costs using CAP cases as self‐control (before–after) and with matched controls (case–control). Results Sixty‐five thousand eight hundred four CAP episodes (39% inpatient‐treated episodes) were identified. Average inpatient and outpatient episode lengths were 32.8 ± 46.9 and 12.4 ± 27.3 days, respectively, and overall incidence was 4,482/100,000 person‐years. Thirty‐day case fatality was 8.5% for inpatient and 3.8% for outpatient CAP. The average CAP episode cost was $8,606 ($18,670 for inpatient, $2,394 for outpatient). The incremental cost of a CAP episode in the before‐and‐after and case–control analyses was approximately $10,000. Conclusion An estimated 1.3 million CAP cases and 74,000 CAP‐related deaths were found, with an economic burden of $13 billion annually in the Medicare fee‐for‐service population. Preventing CAP in this population may substantially reduce healthcare costs.