Clinical and economic burden of community-acquired pneumonia in the Medicare fee-for-service population

Objectives: To estimate current community-acquired pneumonia (CAP) incidence and its associated economic burden in the Medicare fee-for-service (FFS) population.

Design: Retrospective.

Setting: The 2007/08 Medicare Standard Analytic Files, a nationally representative random sample (5%) of Medicare beneficiaries enrolled in the FFS program.

Participants: Residents of one of the 50 U.S. states or the District of Columbia aged 18 and older on July 1, 2007, with continuous Part A and Part B coverage during calendar year 2007.

Measurements: Incidence, episode length, mortality, and costs were assessed. All-cause costs were assessed using three methodologies: costs during the episode, and incremental costs using CAP cases as self-control (before-after) and with matched controls (case-control).

Results: Sixty-five thousand eight hundred four CAP episodes (39% inpatient-treated episodes) were identified. Average inpatient and outpatient episode lengths were 32.8 ± 46.9 and 12.4 ± 27.3 days, respectively, and overall incidence was 4,482/100,000 person-years. Thirty-day case fatality was 8.5% for inpatient and 3.8% for outpatient CAP. The average CAP episode cost was $8,606 ($18,670 for inpatient, $2,394 for outpatient). The incremental cost of a CAP episode in the before-and-after and case-control analyses was approximately $10,000.

Conclusion: An estimated 1.3 million CAP cases and 74,000 CAP-related deaths were found, with an economic burden of $13 billion annually in the Medicare fee-for-service population. Preventing CAP in this population may substantially reduce healthcare costs.