Attributable healthcare utilization and cost of pneumonia due to drug-resistant streptococcus pneumonia: a cost analysis.
BACKGROUND
The burden of disease due to S. pneumoniae (pneumococcus), particularly pneumonia, remains high despite the widespread use of vaccines. Drug resistant strains complicate clinical treatment and may increase costs. We estimated the annual burden and incremental costs attributable to antibiotic resistance in pneumococcal pneumonia.


METHODS
We derived estimates of healthcare utilization and cost (in 2012 dollars) attributable to penicillin, erythromycin and fluoroquinolone resistance by taking the estimate of disease burden from a previously described decision tree model of pneumococcal pneumonia in the U.S. We analyzed model outputs assuming only the existence of susceptible strains and calculating the resulting differences in cost and utilization. We modeled the cost of resistance from delayed resolution of illness and the resulting additional health services.


RESULTS
Our model estimated that non-susceptibility to penicillin, erythromycin and fluoroquinolones directly caused 32,398 additional outpatient visits and 19,336 hospitalizations for pneumococcal pneumonia. The incremental cost of antibiotic resistance was estimated to account for 4% ($91 million) of direct medical costs and 5% ($233 million) of total costs including work and productivity loss. Most of the incremental medical cost ($82 million) was related to hospitalizations resulting from erythromycin non-susceptibility. Among patients under age 18 years, erythromycin non-susceptibility was estimated to cause 17% of hospitalizations for pneumonia and $38 million in costs, or 39% of pneumococcal pneumonia costs attributable to resistance.


CONCLUSIONS
We estimate that antibiotic resistance in pneumococcal pneumonia leads to substantial healthcare utilization and cost, with more than one-third driven by macrolide resistance in children. With 5% of total pneumococcal costs directly attributable to resistance, strategies to reduce antibiotic resistance or improve antibiotic selection could lead to substantial savings.
Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, 100 Theory Ave, Suite 110, Irvine, CA 92697, USA.
Courtney A
CA
Reynolds
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Ave, 3rd Floor, Boston, MA 02215, USA ; Division of General Pediatrics, Boston Children's Hospital, 300 Longwood Ave, Hunnewell G, Boston, MA 02115, USA.
Jonathan A
JA
Finkelstein
Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612, USA.
G Thomas
GT
Ray
Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.
Matthew R
MR
Moore
Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, 100 Theory Ave, Suite 110, Irvine, CA 92697, USA.
Susan S
SS
Huang
Antibiotic resistance; DRSP; Healthcare utilization; Streptococcus pneumoniae