366. Economic Burden Associated with Community-acquired Pneumonia (CAP) Using Medicare 5% Random Sample
Session: Poster Abstract Session: Community and Healthcare Acquired Pneumonia - Epidemiology
Friday, October 21, 2011
Room: Poster Hall B1
Background:  Pneumonia is a leading cause of hospitalization in older adults. However, few data exist on the economic burden associated with community-acquired pneumonia (CAP).

Methods: A retrospective study of the Medicare 5% random sample was conducted to estimate the incremental healthcare cost and resource use of CAP.   In patients with Medicare Parts A and B primary coverage, CAP episodes were identified from claims between 7/1/2007 and 6/30/2008. CAP was defined as either an inpatient claim with a primary diagnosis of pneumonia, or sepsis/respiratory failure as primary and pneumonia as secondary diagnosis, or an outpatient claim for pneumonia and a chest x-ray within 14 days of diagnosis.  CAP identification was further refined by excluding patients who were hospitalized or institutionalized in the 2 weeks prior to the diagnosis.  In addition, patients were required to have continuous Medicare coverage and be alive 6-months before and after the CAP diagnosis date with no evidence of CAP during the pre-CAP period.  Incremental all-cause Medicare allowable costs and utilization were estimated using two approaches: 1) 6-month pre-post CAP analysis among CAP patients (self as control); 2) 6-month follow-up of CAP vs. non-CAP patients, 1:1 propensity-score matched for age, gender, race, pneumonia risk level and comorbidities.

Results:  We identified 53,535 patients with at least one CAP episode.  In the pre-post analysis, the pre to post 6-month per patient costs increased by $10,881.  In the CAP vs. non-CAP approach, 6-month per patient costs were $9,620 greater in the CAP arm than in their matched controls.  In both methods, the cost increases were statistically significant in all age groups and in all medical components (Part A and Part B); and hospitalization costs accounted for the bulk of the increases (62% vs. 60%, respectively).  The total number of medical claims and inpatient days was also higher in the 6-month post-CAP period than the 6-month pre-CAP period and higher in CAP patients compared to matched controls.

Conclusion: The results suggest a large, incremental burden of CAP to Medicare and its beneficiaries during the study period.   Preventing CAP in this patient population may substantially reduce overall healthcare resource utilization and costs.

Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Holly Yu, MSPH, Pfizer, Inc., Colleveville, PA, Stephan Dunning, MBA, Chronic Diseases Research Group, Minneapolis, MN, Minneapolis, MN, Jaime Rubin, MA, i3 Innovus, Medford, MA, Suying Li, PhD, 2Chronic Diseases Research Group, Minneapolis, MN and Reiko Sato, Ph.D., Pfizer, Inc., Collegeville, PA


H. Yu, Pfizer, Inc: Employee, Salary

S. Dunning, Chronic Diseases Research Group: Research Contractor, Research grant

J. Rubin, Chronic Diseases Research Group: Collaborator, Research grant

S. Li, Chronic Diseases Research Group: Research Contractor, Research grant

R. Sato, Pfizer Inc.: Employee, Salary

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.