Background: Community-acquired pneumonia (CAP) is a serious clinical problem, causing hospitalization in about 20% of cases and death in up to 16% of hospitalized patients. Work-loss cost estimates indicate that the treatment of CAP also has a large economic impact. The purpose of this study was to assess the medical and prescription drug (treatment) costs of managing CAP in an employed population.
Method: The costs of CAP were determined from an administrative claims database covering the years 1996 to 1998 for an employed population and their dependents [65 years of age (100,000 population)]. Treatment costs for managing both inpatient and outpatient cases of CAP were calculated from payments by the health plan.
Results: A total of 7,249 episodes of CAP among 6,415 individuals were identified. The hospitalization rate was 19.6%, and the mortality rate for those hospitalized was 9.1%. Patients requiring hospitalization were older and had more comorbid conditions. The mean (± SD) treatment cost for an inpatient episode of CAP (including all inpatient and outpatient medical care) was $10,227 ± 15,342. The costs for inpatients who died during hospitalization (mean cost, $15,822 ± 26,541) were higher than for episodes in which patients were discharged from the hospital alive (mean cost, $9,595 ± 13,641). The mean treatment cost for an outpatient episode of CAP was $466 ± 1,038.
Conclusions: The treatment cost of managing CAP in this employed population was higher than previously estimated. It is estimated that the annual cost of treating CAP in the United States is $12.2 billion.