title: Healthcare utilization and costs associated with S. aureus and P. aeruginosa pneumonia in the intensive care unit: a retrospective observational cohort study in a US claims database.
abstract: BACKGROUND
  Staphylococcus aureus and Pseudomonas aeruginosa are major causes of pneumonia in intensive care unit (ICU) patients. Limited data exist regarding the health economic impact of S. aureus and P. aeruginosa pneumonias in the ICU setting.
  
  
  METHODS
  We conducted a retrospective observational cohort study using a 29.6 million enrollee US medical and pharmacy administrative claims database. ICU patients with S. aureus or P. aeruginosa infection per International Classification of Diseases, 9th ed. coding between 01/01/2007-8/31/2012 were compared with ICU patients without any pneumonia or infections of interest. Primary outcomes were costs in 2012 US dollars, healthcare utilization and all-cause mortality associated with hospital-acquired S. aureus or P. aeruginosa pneumonia, and the relative odds of incurring higher costs due to a comorbid condition.
  
  
  RESULTS
  Patients with S. aureus or P. aeruginosa pneumonia had longer mean hospital (37.9 or 55.4 vs 7.2 days, P < .001) and ICU stays (6.9 or 14.8 vs 1.1 days, P < .001), a higher rate of mechanical ventilation (62.6 % or 62.3 % vs 7.4 %, P < .001), higher mortality (16.0 % or 20.2 % vs 3.1 %, P < .001), and higher total mean hospitalization costs ($146,978 or $213,104 vs $33,851, P < .001) vs controls. Pneumonia survivors had significantly increased risk of rehospitalization within 30 days (27.2 % or 31.1 % vs 15.3 %, P < .001). Comorbid conditions were not associated with increased cost in the pneumonia cohorts.
  
  
  CONCLUSIONS
  Healthcare costs and resource utilization were high among ICU patients with S. aureus or P. aeruginosa pneumonia. Reducing the incidence of these infections could lead to substantial cost savings in the United States.
authors.affiliation: MedImmune, Gaithersburg, USA. moe.kyaw@sanofipasteur.com.|Current author address: Sanofi Pasteur, Swiftwater, PA, USA. moe.kyaw@sanofipasteur.com.
authors.forename: Moe H
authors.initials: MH
authors.lastname: Kyaw
authors.affiliation: Healthcore, Wilmington, DE, USA. dkern@healthcore.com.
authors.forename: David M
authors.initials: DM
authors.lastname: Kern
authors.affiliation: Healthcore, Wilmington, DE, USA. szhou@healthcore.com.
authors.forename: Siting
authors.initials: S
authors.lastname: Zhou
authors.affiliation: Healthcore, Wilmington, DE, USA. otunceli@healthcore.com.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Tunceli
authors.affiliation: MedImmune, Gaithersburg, USA. jafrih@medimmune.com.
authors.forename: Hasan S
authors.initials: HS
authors.lastname: Jafri
authors.affiliation: MedImmune, Gaithersburg, USA. falloonj@medimmune.com.
authors.forename: Judith
authors.initials: J
authors.lastname: Falloon
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003422:Critical Care; D003428:Cross Infection / Q000191:economics*; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000191:economics*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology; D011550:Pseudomonas aeruginosa; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000191:economics*; D013211:Staphylococcus aureus; D014481:United States