title: The clinical and economic burden of pneumonia in patients enrolled in Medicare receiving dialysis: a retrospective, observational cohort study.
abstract: End-stage renal disease (ESRD) patients receiving dialysis are at particular risk for infection. We assessed the clinical and economic burden of pneumonia in a population of Medicare-enrolled ESRD patients with respect to incidence and case fatality rates, rates of all-cause and cardiovascular hospitalization, and costs.
  
  
  
  Patients received dialysis between 01 January 2009 and 31 December 2011 and were enrolled in Medicare Parts A and B. Pneumonia episodes were identified from institutional and supplier claims. Patients were considered at-risk from first date of Medicare coverage and were censored upon transplant, withdrawal from dialysis, recovery of renal function, loss of Medicare benefits, or death. Linear mixed-effects models were used to assess hospitalization rates and costs over the 3 months prior to and 12 months following pneumonia episodes.
  
  
  
  The pneumonia incidence rate for the study period was 21.4 events/100 patient-years; the majority of episodes (90.1%) required inpatient treatment. The 30-day case fatality rate was 10.7%. Compared to month -3 prior to event, rates of all-cause and cardiovascular hospitalization were higher in the month of the pneumonia episode (IRR, 4.61 and 4.30). All-cause admission rates remained elevated through month 12; cardiovascular admission rates remained elevated through month 6. Mean per-patient per-month costs were $10,976 higher in the month of index episode compared to month -3, largely driven by increased inpatient costs, and remained elevated through end of 12-month follow-up.
  
  
  
  Pneumonia episodes are frequent among ESRD patients and result in hospitalizations and greater overall costs to Medicare over the following year.
authors.affiliation: DaVita Clinical Research, 825 South 8th Street, Minneapolis, MN, USA. scott.sibbel@davita.com.
authors.forename: Scott
authors.initials: S
authors.lastname: Sibbel
authors.affiliation: Pfizer Inc, Collegeville, PA, USA.
authors.forename: Reiko
authors.initials: R
authors.lastname: Sato
authors.affiliation: DaVita Clinical Research, 825 South 8th Street, Minneapolis, MN, USA.
authors.forename: Abigail
authors.initials: A
authors.lastname: Hunt
authors.affiliation: DaVita Clinical Research, 825 South 8th Street, Minneapolis, MN, USA.
authors.forename: Wendy
authors.initials: W
authors.lastname: Turenne
authors.affiliation: DaVita Clinical Research, 825 South 8th Street, Minneapolis, MN, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Brunelli
mesh_terms: D000368:Aged; D015331:Cohort Studies; D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs / Q000639:trends; D006760:Hospitalization / Q000639:trends; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D006278:Medicare / Q000191:economics* / Q000639:trends; D008875:Middle Aged; D011014:Pneumonia / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D006435:Renal Dialysis / Q000191:economics* / Q000639:trends; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: Costs; Dialysis; End-stage renal disease; Hospitalization; Infection; Pneumonia