Community-acquired pneumonia: economics of inpatient medical care vis-à-vis clinical severity.
OBJECTIVE
To assess the direct and indirect costs of diagnosing and treating community-acquired pneumonia (CAP), correlating those costs with CAP severity at diagnosis and identifying the major cost drivers.


METHODS
This was a prospective cost analysis study using bottom-up costing. Clinical severity and mortality risk were assessed with the pneumonia severity index (PSI) and the mental Confusion-Urea-Respiratory rate-Blood pressure-age ≥ 65 years (CURB-65) scale, respectively. The sample comprised 95 inpatients hospitalized for newly diagnosed CAP. The analysis was run from a societal perspective with a time horizon of one year.


RESULTS
Expressed as mean ± standard deviation, in Euros, the direct and indirect medical costs per CAP patient were 696 ± 531 and 410 ± 283, respectively, the total per-patient cost therefore being 1,106 ± 657. The combined budget impact of our patient cohort, in Euros, was 105,087 (66,109 and 38,979 in direct and indirect costs, respectively). The major cost drivers, in descending order, were the opportunity cost (lost productivity); diagnosis and treatment of comorbidities; and administration of medications, oxygen, and blood derivatives. The CURB-65 and PSI scores both correlated with the indirect costs of CAP treatment. The PSI score correlated positively with the overall frequency of use of health care services. Neither score showed any clear relationship with the direct costs of CAP treatment.


CONCLUSIONS
Clinical severity at admission appears to be unrelated to the costs of CAP treatment. This is mostly attributable to unwarranted hospital admission (or unnecessarily long hospital stays) in cases of mild pneumonia, as well as to over-prescription of antibiotics. Authorities should strive to improve adherence to guidelines and promote cost-effective prescribing practices among physicians in southeastern Europe.
University of Kragujevac, Center for Clinical Medicine, Pulmonology Department, Kragujevac, Serbia. Pulmonology Department, University of Kragujevac Center for Clinical Medicine, Kragujevac, Serbia.
Vojislav
V
Cupurdija
University of Kragujevac, Center for Clinical Medicine, Pulmonology Department, Kragujevac, Serbia. Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia; and Head. Pulmonology Department, University of Kragujevac Center for Clinical Medicine, Kragujevac, Serbia.
Zorica
Z
Lazic
University of Kragujevac, Center for Clinical Medicine, Pulmonology Department, Kragujevac, Serbia. Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia; and Internist. Pulmonology Department, University of Kragujevac Center for Clinical Medicine, Kragujevac, Serbia.
Marina
M
Petrovic
University of Kragujevac, Center for Clinical Medicine, Pulmonology Department. Pulmonology Department, University of Kragujevac Center for Clinical Medicine, Kragujevac, Serbia.
Slavica
S
Mojsilovic
University of Kragujevac, Center for Clinical Medicine, Kragujevac, Serbia. Intensive Care Unit, University of Kragujevac Center for Clinical Medicine, Kragujevac, Serbia.
Ivan
I
Cekerevac
University of Defence, Military Medical Academy, Medical Faculty, Belgrade, Serbia. Centre for Clinical Pharmacology, Medical Faculty, Military Medical Academy, University of Defence, Belgrade, Serbia.
Nemanja
N
Rancic
University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia. Graduate Program in Health Economics and Pharmacoeconomics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.
Mihajlo
M
Jakovljevic
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics; D015897:Comorbidity; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000191:economics / Q000628:therapy*; D011446:Prospective Studies; D012307:Risk Factors; D055771:Serbia / Q000453:epidemiology; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D055815:Young Adult
Cost of illness; Costs and cost analysis; Health care costs; Hospitalization; Pneumonia; Severity of illness index