title: Hospitalization costs for community-acquired pneumonia in Dutch elderly: an observational study.
abstract: Community-acquired pneumonia (CAP) is one of the most common infections, especially in the elderly (≥65 years). The aim of this study was to quantify hospitalization costs for CAP in different age groups and in patients with different CAP risk profiles. Secondary objectives were to assess disease severity differences between placebo and vaccine receiving participants and identify cost driving factors of CAP in hospitalized elderly in the Netherlands.
  
  
  
  This prospective cohort study of hospitalized CAP patients was executed in parallel to the Community Acquired Pneumonia Immunization Trial in Adults (CAPiTA). Within the CAPiTA, a cohort of 84,496 subjects aged ≥65, all suspected CAP-episodes presenting in one of the 58 participating hospitals between September 2008 and August 2013 were included. CAP was diagnosed on clinical and radiographical criteria. Invasive pneumococcal disease (IPD) and non-IPD-CAP episodes, regardless of the causing pathogen, were evaluated separately. Costs were calculated by multiplying recorded healthcare resources with Dutch unit cost prices for the year 2012. Multivariate regression analysis was performed to identify cost drivers.
  
  
  
  In the sentinel hospitals 3225 suspected CAP and IPD episodes were included, of which 1933 were radiographically confirmed by chest X-ray. Analyses were conducted on confirmed CAP episodes only. Overall mean length of hospital stay was 12.1 days, the in-hospital mortality rate was 11.26 %, and mean costs were €8301 (95 % CI: €7760-€8999). When stratified in age-categories 65-74, 75-84 and ≥85, mean hospitalization costs were €8674, €8770 and €6197, respectively (p = 0.649). IPD-CAP and non-IPD-CAP mean hospitalization costs were €13,611 and €8081, respectively. Higher CURB-65 score and individuals at medium risk for developing pneumococcal disease were significantly associated with higher costs. Being male, lower age, previous admissions, lower risk, lower urbanity and higher socio-economic status were associated with lower costs.
  
  
  
  Mean hospitalization costs of a CAP subject were €8301 and higher for IPD-CAP compared to non-IPD-CAP cases. Medium risk patients and higher CURB-65 scores were identified as cost driving factors.
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. c.e.vissink-2@umcutrecht.nl.|Present address: Department of Psychiatry, University Medical Center Utrecht, A01.126, Heidelberglaan 100, Utrecht, 3508, GA, The Netherlands. c.e.vissink-2@umcutrecht.nl.
authors: Conrad E
authors: CE
authors: Vissink
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.|Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Susanne M
authors: SM
authors: Huijts
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: G Ardine
authors: GA
authors: de Wit
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.|Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Marc J M
authors: MJ
authors: Bonten
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Marie-Josée J
authors: MJ
authors: Mangen
mesh_terms: D000368:Aged; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000191:economics* / Q000401:mortality; D005260:Female; D017048:Health Care Costs; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay; D008297:Male; D009426:Netherlands; D011008:Pneumococcal Infections / Q000191:economics; D011014:Pneumonia / Q000191:economics* / Q000401:mortality; D011446:Prospective Studies
keywords: Community-acquired pneumonia; Costing study; Elderly; Hospitalization; Invasive pneumococcal disease; Risk-groups