A retrospective study to assess the epidemiological and economic burden of pneumococcal diseases in adults aged 50 years and older in Taiwan

Abstract

Objective:

Invasive pneumococcal disease (IPD) and pneumococcal pneumonia cause substantial morbidity and mortality worldwide. This retrospective study was conducted to estimate the disease burden from pneumococcal disease in older adults in Taiwan from a health insurer’s perspective.

Methods:

Data for the years 2002–2009 from patients aged ≥50 years with insurance records indicating pneumococcal meningitis, pneumococcal bacteremia, or hospitalized or outpatient pneumonia were obtained from the National Health Insurance Research Database in Taiwan. Admission data for inpatients, visit data for outpatients, and associated costs were extracted from the database to estimate the incidence, case fatality rates, and direct and indirect costs of pneumococcal disease episodes. These data were applied to the estimated population of Taiwan in 2010 to provide an estimated disease burden for a single year from the payer perspective.

Results:

The average incidence per 100,000 person years was 2.4 for IPD, 278.8 for hospitalized pneumococcal pneumonia, and 1376.4 for outpatient pneumococcal pneumonia. The average case fatality rate was 12.3% for IPD and 10.0% for hospitalized pneumonia. Hospitalized pneumonia accounted for over 90% of direct medical costs. The incidence of hospitalized pneumococcal pneumonia per 100,000 person years was 84.4 for adults of 50–64 years, 313.1 for adults of 65–74 years, 820.3 for adults of 75–84 years, and 1650.9 for adults of 85+ year of age. In 2010, it was estimated there were over 113,000 episodes of pneumococcal disease, causing almost 2000 deaths, with direct medical costs of more than NT$3.4 billion annually.

Conclusions:

Pneumococcal disease is a significant cause of mortality and excess healthcare expense among the elderly in Taiwan. Disease burden in older adults increases with advancing age.

Keywords::

• Streptococcus pneumonia
• Incidence
• Cost
• Taiwan
• Invasive pneumococcal disease
• Pneumonia

Transparency

Declaration of funding

This study was sponsored by Pfizer Inc. Pfizer was involved in the study design, data collection, data analysis, data interpretation, and writing of the manuscript.

Declaration of financial/other relationships

CSR is an employee and shareholder of Pfizer Inc. CHF is an employee of Pfizer Inc. CJC, DW, and LC received a research grant from Pfizer, 2010–2011, to conduct this study. YCH has no conflicts of interest to declare. CMRO Peer Reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

This study is based in part on data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance, Department of Health, and managed by National Health Research Institutes. The interpretation and conclusions contained herein do not represent those of the Bureau of National Health Insurance, Department of Health or National Health Research Institutes. This study is supported by two grants: National Science Council (Grant Number: NSC97-2320-B-182-004-MY3) and the Chang Gung Medical Research Program grant (Grant Number: CMRPD1A0282). Medical writing support was provided by Nancy Price, PhD, at Excerpta Medica and was funded by Pfizer Inc. Authors’ contributions: DW participated in the design of the study and the analysis of the data; CSR participated in the design of the study and the analysis of the data; and YCH participated in the acquisition of the data. LC participated in the design of the study, and the analysis and acquisition of the data. CHF analyzed the data. CJC participated in the design of the study, and the analysis and acquisition of the data.