Methods: A retrospective cohort study was conducted using the Premier database, which contains information from >500 hospitals throughout the United States. Patients with either a primary or secondary ICD-9-CM code for pneumonia and a concomitant positive bacterial culture between January 1, 2008 and March 31, 2015 were identified. Samples were then constructed in a stepwise approach according to definitions of VAP, HAP, HCAP, and CAP. Main outcome measures included hospital costs (adjusted to 2015 USD) and length of stay (LOS) stratified by age and severity. Severity was defined based on the type of care received: “non-ICU” (not admitted to the ICU) and “ICU” (admitted for ≥1 night to the ICU).
Results: In total, 288,538 patients were identified. Of whom, 79.1% were CAP, 11.4% were HCAP, 6.2% were HAP, 2.2% were VAP, and 1.1% were unclassified. Patients with VAP had the highest hospital costs (median: $64,639, IQR: $36,979–$108,391) and the longest LOS (median: 21 days, IQR: 13–33 days). Patients with HAP had a median cost of $27,422 (IQR: $15,075–$52,469) and a median LOS of 14 days (IQR: 9–22 days). Patients with HCAP had a median cost of $16,505 (IQR: $8,706–$32,681) and a median LOS of 9 days (IQR: 6–15 days). Patients with CAP had the lowest hospital costs (median: $11,440, IQR: $6,345–$23,352) and the shortest LOS (median: 7 days, IQR: 5–12 days). Regardless of age and severity, patients with VAP had the highest utilization of hospital resources, followed by HAP, HCAP, and CAP.
Conclusion: The economic burden of pneumonia in the hospital setting is substantial and varies depending on the type of pneumonia. VAP was associated with the highest hospital costs and longest duration of hospital stay. Interventions targeting treatment and prevention of VAP, HAP and HCAP may result in significant cost savings.
S. C. Chang, Genentech: Employee , Salary
N. Mathew, Genentech: Employee , Salary
D. Oliveri, Genesis Research: Employee , Salary
S. Sassman, Genentech: Employee , Salary
A. Kindrick, Genentech: Employee , Salary