Hospitalization costs of adult community-acquired pneumonia in England

Abstract

Objective

Accurate and up-to-date figures of the cost of community-acquired pneumonia (CAP) hospitalization are needed to understand the associated economic burden for public health decision-makers. Recent estimates are lacking, and previously published estimates differ markedly. Our objective was to estimate the current mean cost to the UK National Health Service (NHS) for adult hospitalized CAP.

Methods

All CAP hospitalizations in 2019 for those aged ≥18 years were identified from English Hospital Episode Statistics (HES). Each hospitalization was mapped to the tariff cost paid to the care provider within the NHS, including critical care costs and accounting for length of stay and complexity of the case. Mean hospitalization costs were estimated in total and in individuals with defined underlying comorbidities.

Results

A mean cost of £3,904 was estimated for 187,251 CAP admissions providing a total cost of approximately £731 million per annum. The mean cost was £3,402, excluding critical care costs, and £11,654 for critical care episodes in the 4.4% of admissions receiving this care. Groups at high risk of CAP had higher mean costs, ranging from £4,458 for people with diabetes to £5,215 for those with heart disease aged <65 years and £4,356 for those with heart disease to £4,751 for those with liver disease aged >65 years who comprised 74.3% of admissions overall.

Conclusion

This estimate of the cost of hospitalization for CAP from the total population and in those with certain underlying comorbidities will allow a valid understanding of the cost-benefit of vaccination and evidence-based prioritization of pneumococcal vaccination to those at highest risk.

PLAIN LANGUAGE SUMMARY

• Community-acquired pneumonia (CAP) is a disease that is most commonly caused in England by the bacterium Streptococcus pneumoniae, which infects patients outside of a hospital. Patients who suffer from CAP often require hospitalization, which incurs a cost to the UK National Health Service (NHS). The goal of this study was to establish the annual cost of hospitalized CAP.

• The researchers used England’s national healthcare database, known as Hospital Episodes Statistics (HES), to select all adults in England who were hospitalized for CAP in 2019. For the 187,251 patients hospitalized, an average cost of £3,904 per person was estimated, amounting to a total cost of £731 million per year to the NHS. Most people admitted to hospital with CAP were at risk for the disease (due to factors such as increased age or presence of another disease) and the cost of treatment for this subgroup was disproportionately larger than that for treatment of patients not at risk. Furthermore, while approximately 5% of patients admitted for CAP received critical care during treatment, the average cost for these patients was over £8,000 higher than for those outside this subsection.

• The costs of hospitalization reported in this analysis were higher than previously estimated. The researchers highlighted weaknesses in other studies and limitations of the current study which could explain the difference. This work provides up-to-date figures for the cost of treating CAP in hospital in England. Public health decision-makers can use these estimates to determine the cost-benefit of vaccines that can help protect against important causes of CAP, particularly vaccines that target S. pneumoniae.

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© 2022 Pfizer Ltd. Published by Informa UK Limited, trading as Taylor & Francis Group

Keywords:

• Hospital costs
• pneumonia
• pneumococcal
• risk groups
• community-acquired pneumonia
• NHS cost
• cost of illness

JEL CLASSIFICATION CODES:

• I10
• I11

Transparency

Declaration of funding

This study was funded by Pfizer Ltd, UK. Editorial support was provided by Elizabeth Jennings, Lucid Group and was funded by Pfizer Ltd, UK.

Declaration of financial/other interests

JC, HW, TM, AV, DM, GE are employees of Pfizer Ltd, UK, and hold stock or stock options. MS has received personal fees from GlaxoSmithKline, Pfizer, Merck, AstraZeneca, and Sanofi Pasteur as a speaker at international meetings and as a member of advisory boards and is currently undertaking contract work for Pfizer. GH received payment from Open Health for her contribution to the current study and has received funding for research and scientific consultancy from several pharmaceutical and healthcare companies outside the submitted work.

All reviewers on this manuscript have received an honorarium from JME for their review work. A reviewer on this manuscript has disclosed that they are a consultant for Merk and their institution has received research funding from Seres Therapeutics. The other reviewers have no conflicts of interest.

Acknowledgements

Dave Heaton provided advice on the HES dataset and data analysis, and Matthew O’Connell for data analysis. Hospital Episode Statistics (HES) Data were re-used with the permission of NHS Digital via Harvey Walsh, Open Health Group.