All-cause community acquired pneumonia cost by age and risk in real-world conditions of care in Spain

ABSTRACT

Background

Economic burden of community-acquired pneumonia (CAP) is recognized. Few studies have documented such burden in adults stratified by age, risk status, and by care setting. Spanish data available is scarce.

Method

A retrospective, multicenter study in seven regions of Spain (2017–2019) was conducted. Patients ≥18 years with a primary all-cause CAP episode diagnosis were identified. Episode-level variables included risk-stratum based on presence of an immunocompromising/chronic condition, age, number and length of hospitalized and outpatient episodes, and CAP-related healthcare costs/sick leaves were included.

Results

7,108 episodes [mean age (SD): 59.2 (19.6), 50.42% male, 31.0% hospitalized] were analyzed. Low-risk group accounted for 47.7% of all CAP episodes, 31.5% moderate-risk and 20.8% high-risk. Pneumococcus was identified in 42.2% of cases. Mean CAP episode length was 22.9 days for hospitalized and 13.7 days for outpatient episode. Total healthcare cost for episode was higher in inpatient vs. outpatient: €3,955 vs. €511, p < 0.001, with higher sick leave cost (€3,281 vs. €2,632, p < 0.001), respectively.

Conclusion

CAP required hospitalization cost is high regardless of age or comorbidities for the Spanish NHS. Given that almost half of the patients in this study did not have traditional risk factors for CAP, better preventative strategies should seriously be considered.

KEYWORDS:

• Community-acquired pneumonia
• real world
• risk range
• outpatient assistance
• hospital assistance
• cost

Acknowledgments

Authors thanks D Navarro, a past employee of Pfizer SLU, for her valuable contribution in the conception and design of the study, and R Sato, Pfizer Inc, NY,NY, for your valuable review of draft manuscript.

Declaration of interest

A Sicras-Mainar and A Sicras-Navarro are employees of Atrys Health SA who were paid consultants to Pfizer in connection with this manuscript. J Rejas, N Lwoff and C Méndez are full employees of Pfizer, SLU, and participated in the conception and design of the study, or in the interpretation of data and in critical revision and/or drafting of the final version of the manuscript. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

The study was conceived by J Rejas, A Sicras-Mainar and A Sicras-Navarro. Data collection and statistical analysis was made by A Sicras-Mainar and A Sicras-Navarro. Interpretation of data was made by all authors. All authors drafted or revised critically and approved the final version of submitted manuscript for publication.

Disclaimer

The authors state that the manuscript was approved by the Institutional Research Board of the Hospital de Terrassa in Barcelona (Protocol Code: PFI-NAC-2020-01, Ethic committee code: Code: 01-20-399-073) on June 8^th, 2020. Patient consent was not obtained as Spanish legislation excludes existing data that are aggregated for analysis and personal data are stripped of identifying details as specified in Spanish Law 15/1999, of 13 December, on Personal Data Protection.

Supplementary material

Supplemental data for this article can be accessed here

Additional information

Funding

Atrys and Pfizer worked together for the development of the manuscript.