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Healthcare utilization and cost of pneumococcal disease in the United States

BACKGROUND: Streptococcus pneumoniae continues to cause a variety of common clinical syndromes; despite vaccination programs for both adults and children. The total U.S. burden of pneumococcal disease is unknown. METHODS: We constructed a decision tree-based model to estimate U.S. healthcare utilization and costs of pneumococcal disease in 2004. Data were obtained from the 2004-2005 National (Hospital) Ambulatory Medical Care Surveys (outpatient visits; antibiotics) and the National Hospital Discharge Survey (hospitalization rates); and CDC surveillance data. Other assumptions regarding the incidence of each syndrome due to pneumococcus; expected health outcomes; and healthcare utilization were derived from literature and expert opinion. Healthcare and time costs used 2007 dollars. RESULTS: We estimate that; in 2004; pneumococcal disease caused 4.0 million illness episodes; 22;000 deaths; 445;000 hospitalizations; 774;000 emergency department visits; 5.0 million outpatient visits; and 4.1 million outpatient antibiotic prescriptions. Direct medical costs totaled $3.5 billion. Pneumonia (866;000 cases) accounted for 22% of all cases and 72% of pneumococcal costs. In contrast; acute otitis media and sinusitis (1.5 million cases each) comprised 75% of cases but only 16% of direct medical costs. Patients >/= 65 years old; accounted for most serious cases and the majority of direct medical costs ($1.8 billion in healthcare costs annually). In this age group; pneumonia caused 242;000 hospitalizations; 1.4 million hospital days; 194;000 emergency department visits; 374;000 outpatient visits; and 16;000 deaths. However; if work loss and productivity are considered; the cost of pneumococcal disease among younger working adults (18-<50) nearly equaled those >/= 65. CONCLUSIONS: Pneumococcal disease remains a substantial cause of morbidity and mortality even in the era of routine pediatric and adult vaccination. Continued efforts are warranted to reduce serious pneumococcal disease; especially adult pneumonia.

Authors: Huang SS; Johnson KM; Ray GT; Wroe P; Lieu TA; Moore MR; Zell ER; Linder JA; Grijalva CG; Metlay JP; Finkelstein JA

Vaccine. 2011 Apr 18;29(18):3398-412. Epub 2011 Mar 11.

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