title: The incidence rate and economic burden of community-acquired pneumonia in a working-age population.
abstract: BACKGROUND
  Community-acquired pneumonia (CAP) is frequently associated with the very young and the elderly but is a largely underrecognized burden among working-age adults. Although the burden of CAP among the elderly has been established, there are limited data on the economic burden of CAP in the employed population.
  
  
  OBJECTIVE
  To assess the economic impact of CAP in US working-age adults from an employer perspective by estimating the incidence rate and costs of healthcare, sick time, and short-term disability for this patient population.
  
  
  METHODS
  This retrospective cohort study is based on data from 2 Truven Health Analytics databases. The study population consisted of commercially insured active employees aged 18 to 64 years, early retirees aged <65 years, and adult dependents of both cohorts. CAP was identified using medical claims with pneumonia diagnosis codes during the 2009 calendar year. Incidence rate, episode level, and annual costs were stratified by age and by risk based on the presence of comorbidities. Descriptive statistics were used to compare healthcare (ie, medical and pharmacy) costs, sick time, and short-term disability costs between the cohorts with and without CAP. Linear regression was used to estimate the average annual incremental healthcare cost in employed patients with inpatient or outpatient CAP versus individuals without CAP.
  
  
  RESULTS
  Study eligibility was met by 12,502,017 employed individuals, including 123,920 with CAP and 12,378,097 without CAP; the overall incidence rate of CAP was 10.6 per 1000 person-years. Among individuals with and without CAP, the costs of healthcare, sick time, and short-term disability increased with advancing age and with higher risk status. The mean annual healthcare costs were $20,961 for patients with CAP and $3783 for individuals without CAP. Overall, the mean costs of sick time and short-term disability were $1129 and $1016, respectively, in active employees with CAP, and $853 and $322, respectively, in their counterparts without CAP. Compared with individuals without CAP, the average annual incremental healthcare cost ranged from $39,889 to $113,837 for inpatient management of patients with CAP and from $4170 to $31,524 for outpatient management of patients with CAP, depending on the risk level.
  
  
  CONCLUSIONS
  CAP is a common and costly infection among working-age individuals, especially in patients with comorbidities. Prevention strategies, such as influenza and pneumococcal vaccination, that target working-age adults with underlying medical conditions may be the most valuable in reducing the morbidity and costs associated with CAP.
authors.affiliation: Actuarial Analyst, Milliman, New York, NY.
authors.forename: Jonah
authors.initials: J
authors.lastname: Broulette
authors.affiliation: Director, Market Access, Pfizer Specialty Care Business Unit, Pfizer Inc, Collegeville, PA.
authors.forename: Holly
authors.initials: H
authors.lastname: Yu
authors.affiliation: Principal and Consulting Actuary, Milliman, New York, NY.
authors.forename: Bruce
authors.initials: B
authors.lastname: Pyenson
authors.affiliation: Consulting Actuary, Milliman, New York, NY.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Iwasaki
authors.affiliation: Director, Market Access, Pfizer Specialty Care Business Unit, Pfizer Inc, Collegeville, PA.
authors.forename: Reiko
authors.initials: R
authors.lastname: Sato