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Weycker D, Moynahan A, Silvia A, Sato R. Attributable Cost of Adult Hospitalized Pneumonia Beyond the Acute Phase. PHARMACOECONOMICS - OPEN 2021; 5:275-284. [PMID: 33225412 PMCID: PMC8160038 DOI: 10.1007/s41669-020-00240-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND While much is known about the cost of community-acquired pneumonia (CAP) during the acute phase of illness, little is known about the potential attributable cost of CAP thereafter. OBJECTIVE The aim of this study was to assess long-term attributable costs associated with CAP among adults in US clinical practice. METHODS A retrospective matched cohort design and data from a US private healthcare claims repository were employed. In each month during the study period (2011-2016), adults who were hospitalized for CAP in that month ('CAP patients') were matched (1:1, without replacement) on demographic, clinical, and healthcare profiles to adults who did not develop CAP in that month ('comparison patients'). All-cause healthcare expenditures were tallied for the qualifying CAP hospitalization and during the 30-day period post-discharge (collectively, 'acute phase'), as well as from the end of the acute phase to the end of the 3-year follow-up period ('long-term phase'). RESULTS The study population included 43,975 matched pairs of CAP patients and comparison patients. Expenditures averaged $33,380 (95% confidence interval [CI] $32,665-$34,161) for the CAP hospitalization and $4568 (95% CI $4385-$4749) during the 30-day period thereafter (vs. $2075 [95% CI $1989-$2167] in total for the comparison patients). During the long-term phase, all-cause expenditures averaged $83,463 (95% CI $81,318-$85,784) for CAP patients versus $51,017 (95% CI $49,553-$52,491) for comparison patients, and thus attributable expenditures during this phase totaled $32,446 (95% CI $29,847-$35,075). The majority of attributable CAP expenditures (53% of $68,319) occurred during the acute phase, while 21%, 14%, and 12% occurred during the first, second, and third years, respectively, after the acute phase. CONCLUSIONS Our findings provide additional evidence that the cost of CAP requiring hospitalization is high, and that the impact of CAP extends well beyond the expected time for resolution of acute inflammatory signs.
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Affiliation(s)
- Derek Weycker
- Policy Analysis Inc. (PAI), 822 Boylston Street, Suite 206, Chestnut Hill, MA, 02467, USA.
| | - Aaron Moynahan
- Policy Analysis Inc. (PAI), 822 Boylston Street, Suite 206, Chestnut Hill, MA, 02467, USA
| | - Amanda Silvia
- Policy Analysis Inc. (PAI), 822 Boylston Street, Suite 206, Chestnut Hill, MA, 02467, USA
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Divino V, Schranz J, Early M, Shah H, Jiang M, DeKoven M. The annual economic burden among patients hospitalized for community-acquired pneumonia (CAP): a retrospective US cohort study. Curr Med Res Opin 2020; 36:151-160. [PMID: 31566005 DOI: 10.1080/03007995.2019.1675149] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To assess the 1-year economic burden among patients hospitalized for community-acquired pneumonia (CAP) in the US.Methods: Adult patients hospitalized for CAP between 1/2012 and 12/2016 were identified from the IQVIA hospital charge data master (CDM) linked to the IQVIA Real-World Data Adjudicated Claims - US Database (date of admission = index date). Patients had continuous enrollment 180-days pre- and 360-days post-index, and empiric antimicrobial treatment (monotherapy [EM] or combination therapy [EC]) and chest x-ray on the index date or day after. All-cause and CAP-related healthcare resource utilization and cost were assessed over the 1-year follow-up. Generalized linear models (GLM) examined adjusted total cost.Results: The cohort comprised 1624 patients hospitalized for CAP (mean age 50.3; 52.8% female). The majority (78.2%) initiated EC, most frequently with beta-lactams + macrolides (30.4%). The index hospitalization was associated with a mean length of stay (LOS) of 5.7 days and mean cost of $17,736; 22.7% had a transfer to the intensive care unit (ICU). All-cause readmission rates at 30- and 180-days were 8.8% and 20.1%, respectively. Mean annual all-cause total cost was $61,928; one-third (33.8%, $20,954) was related to CAP. The primary cost driver was inpatient care, which accounted for more than half (56.0%) of total all-cause cost and 94.3% of total CAP-related cost. Mean total inpatient cost was significantly higher among EC versus EM patients ($37,106 versus $25,999, p = .0399). Adjusted mean total all-cause cost was $55,391.Conclusions: Patients hospitalized for CAP incurred a significant annual economic burden, driven substantially by the high cost of hospitalizations.
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Affiliation(s)
- Victoria Divino
- Medical and Scientific Services, Real World Evidence Solutions, IQVIA, Falls Church, VA, USA
| | - Jennifer Schranz
- Clinical Development and Medical Affairs, Nabriva Therapeutics US, Inc, King of Prussia, PA, USA
| | - Maureen Early
- Medical Affairs, Nabriva Therapeutics US, Inc, King of Prussia, PA, USA
| | | | - Miao Jiang
- Medical and Scientific Services, Real World Evidence Solutions, IQVIA, Falls Church, VA, USA
| | - Mitch DeKoven
- Medical and Scientific Services, Real World Evidence Solutions, IQVIA, Falls Church, VA, USA
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Yaghoubi M, Adibi A, Zafari Z, FitzGerald JM, Aaron SD, Johnson KM, Sadatsafavi M. Cost-effectiveness of implementing objective diagnostic verification of asthma in the United States. J Allergy Clin Immunol 2019; 145:1367-1377.e4. [PMID: 31837372 DOI: 10.1016/j.jaci.2019.11.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/31/2019] [Accepted: 11/26/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Asthma diagnosis in the community is often made without objective testing. OBJECTIVE The aim of this study was to evaluate the cost-effectiveness of implementing a stepwise objective diagnostic verification algorithm among patients with community-diagnosed asthma in the United States. METHODS We developed a probabilistic time-in-state cohort model that compared a stepwise asthma verification algorithm on the basis of spirometry testing and a methacholine challenge test against the current standard of care over 20 years. Model input parameters were informed from the literature and with original data analyses when required. The target population was US adults (≥15 years old) with physician-diagnosed asthma. The final outcomes were costs (in 2018 dollars) and quality-adjusted life years (QALYs), discounted at 3% annually. Deterministic and probabilistic analyses were undertaken to examine the effect of alternative assumptions and uncertainty in model parameters on the results. RESULTS In a simulated cohort of 10,000 adults with diagnosed asthma, the stepwise algorithm resulted in removal of the diagnosis of 3,366. This was projected to be associated with savings of $36.26 million in direct costs and a gain of 4,049.28 QALYs over 20 years. Extrapolating these results to the US population indicated an undiscounted potential savings of $56.48 billion over 20 years. The results were robust against alternative assumptions and plausible changes in values of input parameters. CONCLUSION Implementation of a simple diagnostic testing algorithm to verify asthma diagnosis might result in substantial savings and improvement in patients' quality of life.
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Affiliation(s)
- Mohsen Yaghoubi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Amin Adibi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Zafar Zafari
- Pharmaceutical Health Services Research at University of Maryland School of Pharmacy, Baltimore, Md
| | - J Mark FitzGerald
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Shawn D Aaron
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Kate M Johnson
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada; Department of Medicine, University of British Columbia, Vancouver, Canada.
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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 2018; 13:139-152. [PMID: 30596308 DOI: 10.1080/17476348.2019.1562339] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Community-acquired pneumonia (CAP) is a significant global health problem and leading cause of death and hospitalization in both the US and abroad. Increasing macrolide resistance among Streptococcus pneumoniae and other pathogens results in a greater disease burden, along with changing demographics and a higher preponderance of comorbid conditions. Areas covered: This review summarizes current data on the clinical and economic burden of CAP, with particular focus on community-acquired bacterial pneumonia (CABP). Incidence, morbidity and mortality, and healthcare costs for the US and other regions of the world are among the topics covered. Major factors that are believed to be contributing to the increased impact of CABP, including antimicrobial resistance, the aging population, and the incidence of comorbidities are discussed, as well as unmet needs in current CABP management. Expert commentary: The clinical and economic burden of CABP is staggering, far-reaching, and expected to increase in the future as new antibiotic resistance mechanisms emerge and the world's population ages. Important measures must be initiated to stabilize and potentially decrease this burden. Urgent needs in CABP management include the development of new antimicrobials, adjuvant therapies, and rapid diagnostics.
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Affiliation(s)
- Paula Peyrani
- a Vaccine Clinical Research and Development , Pfizer Inc , Collegeville , PA , USA
| | - Lionel Mandell
- b Division of Infectious Diseases , McMaster University , Hamilton , Ontario , Canada
| | - Antoni Torres
- c Hospital Clinic, IDIBAPS, Ciberes , University of Barcelona , Barcelona , Spain
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Dodd KE, Mazurek JM. Pneumococcal Vaccination Among Adults With Work-related Asthma. Am J Prev Med 2017; 53:799-809. [PMID: 28964578 PMCID: PMC5912154 DOI: 10.1016/j.amepre.2017.07.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/09/2017] [Accepted: 07/24/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Pneumococcal vaccination is recommended for all adults with asthma and a Healthy People 2020 goal aims to achieve 60% coverage among high-risk adults, including those with asthma. Adults with work-related asthma have more severe asthma symptoms than those with non-work-related asthma and are particularly vulnerable to pneumococcal pneumonia. METHODS To assess pneumococcal vaccination coverage by work-related asthma status among ever-employed adults aged 18-64 years with current asthma, data from the 2012-2013 Behavioral Risk Factor Surveillance System Asthma Call-back Survey for ever-employed adults (18-64 years) with current asthma from 29 states were examined in 2016. Adults with work-related asthma had ever been told by a physician their asthma was work-related. Pneumococcal vaccine recipients self-reported having ever received a pneumococcal vaccine. Multivariate logistic regression was used to calculate adjusted prevalence ratios and associated 95% CIs. RESULTS Among an estimated 12 million ever-employed adults with current asthma in 29 states, 42.0% received a pneumococcal vaccine. Adults with work-related asthma were more likely to have received a pneumococcal vaccine than adults with non-work-related asthma (53.7% versus 35.0%, respectively, prevalence ratio=1.24, 95% CI=1.06, 1.45). Among adults with work-related asthma, pneumococcal vaccine coverage was lowest among Hispanics (36.2%) and those without health insurance (38.5%). CONCLUSIONS Pneumococcal vaccination coverage among adults with work-related asthma and non-work-related asthma is below the Healthy People 2020 target level. Healthcare providers should verify pneumococcal vaccination status in their patients with asthma and offer the vaccine to those not vaccinated.
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Affiliation(s)
- Katelynn E Dodd
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia.
| | - Jacek M Mazurek
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
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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 2017; 12:e0184877. [PMID: 29028810 PMCID: PMC5640217 DOI: 10.1371/journal.pone.0184877] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 09/03/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Recent evidence demonstrates increased short-term risk of cardiac complications and respiratory failure among patients with heart failure (HF) and chronic obstructive pulmonary disease (COPD), respectively, concurrent with an episode of community-acquired pneumonia (CAP). We evaluated patients with pre-existing HF or COPD, beginning 30 days after CAP diagnosis, to determine if CAP had a prolonged impact on their underlying comorbidity. METHODS A retrospective matched-cohort design using US healthcare claims was employed. In each month of accrual, patients with HF or COPD who developed CAP ("CAP patients") were matched (1:1, without replacement, on demographic and clinical profiles) to patients with HF or COPD who did not develop CAP ("comparison patients"). All patients were aged ≥40 years, and were pneumonia free during prior 1-year period. Exacerbation beginning 30 days after the CAP diagnosis and for the subsequent 1-year period were compared between CAP and comparison patients. FINDINGS 38,010 (4·6%) HF patients and 48,703 (5·9%) COPD patients experienced a new CAP episode requiring hospitalization or outpatient care only, and were matched to comparison patients. In the HF subset, CAP patients were 47·2% more likely to experience an exacerbation vs patients without CAP (17·8% vs. 12·1%; p<0·001); in the COPD subset, CAP patients were 42·3% more likely to experience an exacerbation (16·2% vs. 11·4%; p<0·001). CONCLUSIONS Our data provide evidence that CAP foreshadows a prolonged increase in risk of exacerbation of underlying HF or COPD in adults, and suggests a potential benefit to CAP prevention strategies.
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Affiliation(s)
| | - Kimberly M. Shea
- Boston University Schools of Medicine and Public Health, Boston, MA, United States of America
| | - Reiko Sato
- Pfizer Inc., Collegeville, PA, United States of America
| | - Derek Weycker
- Policy Analysis Inc. (PAI), Brookline, MA, United States of America
| | - Stephen I. Pelton
- Boston University Schools of Medicine and Public Health, Boston, MA, United States of America
- Boston Medical Center, Boston, MA, United States of America
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Torres A, Blasi F, Dartois N, Akova M. Which individuals are at increased risk of pneumococcal disease and why? Impact of COPD, asthma, smoking, diabetes, and/or chronic heart disease on community-acquired pneumonia and invasive pneumococcal disease. Thorax 2015. [PMID: 26219979 PMCID: PMC4602259 DOI: 10.1136/thoraxjnl-2015-206780] [Citation(s) in RCA: 196] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Pneumococcal disease (including community-acquired pneumonia and invasive pneumococcal disease) poses a burden to the community all year round, especially in those with chronic underlying conditions. Individuals with COPD, asthma or who smoke, and those with chronic heart disease or diabetes mellitus have been shown to be at increased risk of pneumococcal disease compared with those without these risk factors. These conditions, and smoking, can also adversely affect patient outcomes, including short-term and long-term mortality rates, following pneumonia. Community-acquired pneumonia, and in particular pneumococcal pneumonia, is associated with a significant economic burden, especially in those who are hospitalised, and also has an impact on a patient's quality of life. Therefore, physicians should target individuals with COPD, asthma, heart disease or diabetes mellitus, and those who smoke, for pneumococcal vaccination at the earliest opportunity at any time of the year.
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Affiliation(s)
- Antoni Torres
- Servei de Pneumologia, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBER de Enfermedades Respiratorias (CIBERes), University of Barcelona, Barcelona, Spain
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Cà Granda Ospedale Maggiore, Milan, Italy
| | | | - Murat Akova
- Department of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
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