Community-acquired pneumonia : economics of inpatient medical care vis-à-vis clinical severity
(2015) In Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia 41(1). p.48-57- Abstract
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... (More)
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.
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- author
- Cupurdija, Vojislav ; Lazic, Zorica ; Petrovic, Marina ; Mojsilovic, Slavica ; Cekerevac, Ivan ; Rancic, Nemanja and Jakovljevic, Mihajlo LU
- publishing date
- 2015-03-10
- type
- Contribution to journal
- publication status
- published
- keywords
- Adult, Aged, Aged, 80 and over, Community-Acquired Infections/diagnosis, Comorbidity, Female, Health Care Costs, Hospitalization/economics, Humans, Male, Middle Aged, Pneumonia/diagnosis, Prospective Studies, Risk Factors, Serbia/epidemiology, Severity of Illness Index, Socioeconomic Factors, Young Adult
- in
- Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia
- volume
- 41
- issue
- 1
- pages
- 48 - 57
- publisher
- Sociedade Brasileira de Pneumologia e Tisiologia
- external identifiers
-
- pmid:25750674
- scopus:84924530414
- ISSN
- 1806-3713
- DOI
- 10.1590/S1806-37132015000100007
- language
- English
- LU publication?
- no
- id
- ed0ef741-ecef-43ee-886f-70dff1836fc1
- date added to LUP
- 2018-09-01 22:57:59
- date last changed
- 2024-04-01 09:46:09
@article{ed0ef741-ecef-43ee-886f-70dff1836fc1,
abstract = {{<p>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.</p><p>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.</p><p>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.</p><p>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.</p>}},
author = {{Cupurdija, Vojislav and Lazic, Zorica and Petrovic, Marina and Mojsilovic, Slavica and Cekerevac, Ivan and Rancic, Nemanja and Jakovljevic, Mihajlo}},
issn = {{1806-3713}},
keywords = {{Adult; Aged; Aged, 80 and over; Community-Acquired Infections/diagnosis; Comorbidity; Female; Health Care Costs; Hospitalization/economics; Humans; Male; Middle Aged; Pneumonia/diagnosis; Prospective Studies; Risk Factors; Serbia/epidemiology; Severity of Illness Index; Socioeconomic Factors; Young Adult}},
language = {{eng}},
month = {{03}},
number = {{1}},
pages = {{48--57}},
publisher = {{Sociedade Brasileira de Pneumologia e Tisiologia}},
series = {{Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia}},
title = {{Community-acquired pneumonia : economics of inpatient medical care vis-à-vis clinical severity}},
url = {{http://dx.doi.org/10.1590/S1806-37132015000100007}},
doi = {{10.1590/S1806-37132015000100007}},
volume = {{41}},
year = {{2015}},
}