566. Clinical and Economic Burden of Pneumococcal Disease in US Adults Aged 50 Years and Older
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Despite the widespread use of 23-valent polysaccharide vaccine (PPV) in older adults and the indirect (herd) effects observed from routine use of 7-valent conjugate vaccine (PCV7) among young children, the current clinical and economic burden of pneumococcal disease in older US adults has not been well-documented.
Methods: We estimated the expected annual clinical and economic burden of pneumococcal disease among US adults aged ≥50 years by combining age and risk group-specific data on rates and costs of disease and corresponding population sizes. Pneumococcal disease included invasive pneumococcal disease (IPD) and nonbacteremic pneumococcal pneumonia (NPP). Rates and disease-related risks of death were based on 2006 data from the Active Bacterial Core surveillance (ABCs) as well as other published sources; NPP was assumed--based on available literature--to represent 30% of all-cause nonbacteremic pneumonia. Costs (US$2007) included those for the care of pneumococcal disease (“direct costs”) as well as the value of patient work loss due to disease-related morbidity and mortality (“indirect costs”).
Results: Among the 91.5 million US adults aged ≥50 years, 24,801 cases of IPD (bacteremia: 23,342; meningitis: 1,459), 1,089,152 cases of NPP (165,113 requiring inpatient care, 924,039 requiring outpatient care only), and 57,335 pneumococcal-related deaths are estimated to occur yearly (Table). Annual direct and indirect costs are estimated to total $4.1 billion and $628.8 million, respectively.
Conclusion: Substantial clinical and economic burden of pneumococcal disease among older US adults remains despite the progress made to increase coverage with PPV and the indirect benefits afforded by PCV7 vaccination of young children.
Table. Estimated annual clinical and economic burden of pneumococcal disease in older US adults
Age
50-64
Low/Mod
Age
50-64
High
Age
65-74
Low/Mod
Age
65-74
High
Age
>=75
Low/Mod
Age
>=75
High
Total
No. of Cases:IPD4,7525,4882,0363,6093,0715,84624,801
NPP:Inpatient14,03316,58712,48421,72532,93367,350165,113
Outpatient151,213169,81673,423128,010132,594268,983924,039
No. of Deaths1,2283,9491,1556,6173,93040,45757,335
Costs, US$2007 (000s):Direct:IPD153,945143,48358,93789,24274,534125,947646,090
NPP340,955427,898259,229470,800639,7331,322,6363,461,251
Indirect:IPD137,7786,26717,6201,1468,817511172,140
NPP219,252106,98248,83423,38142,51815,693456,659
Risk profile: low--immunocompetent without chronic medical conditions; mod (moderate)--immunocompetent with chronic medical conditions; high--immunocompromised
Lisa A. Jackson, MD, MPH1, Reiko Sato, PhD2, David Strutton, PhD, MPH2, Derek Weycker, PhD3 and  D. Weycker,
Wyeth Research Role(s): Research Relationship, Other, Employed by PAI, which received funding for this research from Wyeth Research., Received: Research Support.
D. Strutton,
Wyeth Research Role(s): Employee, Received: Salary.
R. Sato,
Wyeth Research Role(s): Employee, Received: Salary.
L. Jackson,
Wyeth Research Role(s): Collaborator, Grant Investigator, Research Contractor, Research Relationship, Scientific Advisor (Review Panel or Advisory Committee), Received: Grant Recipient, Research Grant, Consulting Fee., (1)Center for Health Studies, Seattle, WA, (2)Wyeth Research, Collegeville, PA, (3)Policy Analysis Inc. (PAI), Brookline, MA