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Comorbidities as a driver of the excess costs of community-acquired pneumonia in U.S. commercially-insured working age adults.

Polsky D, Bonafede M, Suaya JA - BMC Health Serv Res (2012)

Bottom Line: On average, indirect costs comprised 21% of total excess costs, ranging from 8% for CHF patients to 27% for COPD patients.Compared to patients without asthma, diabetes, COPD, or CHF, the excess cost of CAP is nearly twice as high for patients with diabetes and COPD and nearly three times as high for patients with CHF.Indirect costs made up a significant but varying portion of excess CAP costs.

View Article: PubMed Central - HTML - PubMed

Affiliation: Perelman School of Medicine and the Wharton School, University of Pennsylvania, Philadelphia, PA, USA. Polsky@mail.med.upenn.edu

ABSTRACT

Background: Adults with certain comorbid conditions have a higher risk of pneumonia than the overall population. If treatment of pneumonia is more costly in certain predictable situations, this would affect the value proposition of populations for pneumonia prevention. We estimate the economic impact of community-acquired pneumonia (CAP) for adults with asthma, diabetes, chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) in a large U.S. commercially-insured working age population.

Methods: Data sources consisted of 2003 through 2007 Thomson Reuters MarketScan Commercial Claims and Encounters and Thomson Reuters Health Productivity and Management (HPM) databases. Pneumonia episodes and selected comorbidities were identified by ICD-9-CM diagnosis codes. By propensity score matching, controls were identified for pneumonia patients. Excess direct medical costs and excess productivity cost were estimated by generalized linear models (GLM).

Results: We identified 402,831 patients with CAP between 2003 through 2007, with 25,560, 32,677, 16,343, and 5,062 episodes occurring in patients with asthma, diabetes, COPD and CHF, respectively. Mean excess costs (and standard error, SE) of CAP were $14,429 (SE=44) overall. Mean excess costs by comorbidity subgroup were lowest for asthma ($13,307 (SE=123)), followed by diabetes ($21,395 (SE=171)) and COPD ($23,493 (SE=197)); mean excess costs were highest for patients with CHF ($34,436 (SE=549)). On average, indirect costs comprised 21% of total excess costs, ranging from 8% for CHF patients to 27% for COPD patients.

Conclusions: Compared to patients without asthma, diabetes, COPD, or CHF, the excess cost of CAP is nearly twice as high for patients with diabetes and COPD and nearly three times as high for patients with CHF. Indirect costs made up a significant but varying portion of excess CAP costs. Returns on prevention of pneumonia would therefore be higher in adults with these comorbidities.

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Distribution of the annualized adjusted total excess cost of pneumonia by selected comorbidity group.
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Figure 1: Distribution of the annualized adjusted total excess cost of pneumonia by selected comorbidity group.

Mentions: Table 4 contains the adjusted overall excess cost of CAP, which are also depicted in Figure 1. CHF patients had the highest total burden of CAP, with costs nearly three times the average excess costs of CAP. CAP for patients with COPD and diabetes costs 86% and 70% more than for a typical patient. The excess cost of CAP for patients with asthma appeared similar to the average excess cost of CAP. On average, the excess cost of CAP was 79% excess direct costs and 21% excess indirect costs. The relationship between excess direct and indirect costs was similar for patients with asthma, diabetes and COPD where indirect costs accounted for 24-27% of total excess costs. Among patients with CHF, total excess costs were predominantly direct costs (92%) compared to indirect costs (8%).


Comorbidities as a driver of the excess costs of community-acquired pneumonia in U.S. commercially-insured working age adults.

Polsky D, Bonafede M, Suaya JA - BMC Health Serv Res (2012)

Distribution of the annualized adjusted total excess cost of pneumonia by selected comorbidity group.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3585380&req=5

Figure 1: Distribution of the annualized adjusted total excess cost of pneumonia by selected comorbidity group.
Mentions: Table 4 contains the adjusted overall excess cost of CAP, which are also depicted in Figure 1. CHF patients had the highest total burden of CAP, with costs nearly three times the average excess costs of CAP. CAP for patients with COPD and diabetes costs 86% and 70% more than for a typical patient. The excess cost of CAP for patients with asthma appeared similar to the average excess cost of CAP. On average, the excess cost of CAP was 79% excess direct costs and 21% excess indirect costs. The relationship between excess direct and indirect costs was similar for patients with asthma, diabetes and COPD where indirect costs accounted for 24-27% of total excess costs. Among patients with CHF, total excess costs were predominantly direct costs (92%) compared to indirect costs (8%).

Bottom Line: On average, indirect costs comprised 21% of total excess costs, ranging from 8% for CHF patients to 27% for COPD patients.Compared to patients without asthma, diabetes, COPD, or CHF, the excess cost of CAP is nearly twice as high for patients with diabetes and COPD and nearly three times as high for patients with CHF.Indirect costs made up a significant but varying portion of excess CAP costs.

View Article: PubMed Central - HTML - PubMed

Affiliation: Perelman School of Medicine and the Wharton School, University of Pennsylvania, Philadelphia, PA, USA. Polsky@mail.med.upenn.edu

ABSTRACT

Background: Adults with certain comorbid conditions have a higher risk of pneumonia than the overall population. If treatment of pneumonia is more costly in certain predictable situations, this would affect the value proposition of populations for pneumonia prevention. We estimate the economic impact of community-acquired pneumonia (CAP) for adults with asthma, diabetes, chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) in a large U.S. commercially-insured working age population.

Methods: Data sources consisted of 2003 through 2007 Thomson Reuters MarketScan Commercial Claims and Encounters and Thomson Reuters Health Productivity and Management (HPM) databases. Pneumonia episodes and selected comorbidities were identified by ICD-9-CM diagnosis codes. By propensity score matching, controls were identified for pneumonia patients. Excess direct medical costs and excess productivity cost were estimated by generalized linear models (GLM).

Results: We identified 402,831 patients with CAP between 2003 through 2007, with 25,560, 32,677, 16,343, and 5,062 episodes occurring in patients with asthma, diabetes, COPD and CHF, respectively. Mean excess costs (and standard error, SE) of CAP were $14,429 (SE=44) overall. Mean excess costs by comorbidity subgroup were lowest for asthma ($13,307 (SE=123)), followed by diabetes ($21,395 (SE=171)) and COPD ($23,493 (SE=197)); mean excess costs were highest for patients with CHF ($34,436 (SE=549)). On average, indirect costs comprised 21% of total excess costs, ranging from 8% for CHF patients to 27% for COPD patients.

Conclusions: Compared to patients without asthma, diabetes, COPD, or CHF, the excess cost of CAP is nearly twice as high for patients with diabetes and COPD and nearly three times as high for patients with CHF. Indirect costs made up a significant but varying portion of excess CAP costs. Returns on prevention of pneumonia would therefore be higher in adults with these comorbidities.

Show MeSH
Related in: MedlinePlus