Treatment Costs of Community-Acquired Pneumonia in an Employed Population

Community-acquired pneumonia (CAP) is a serious clinical problem, causing hospitalization in about 20% of cases and death in up to 16% of hospitalized patients. Work-loss cost estimates indicate that the treatment of CAP also has a large economic impact. The purpose of this study was to assess the medical and prescription drug (treatment) costs of managing CAP in an employed population. The costs of CAP were determined from an administrative claims database covering the years 1996 to 1998 for an employed population and their dependents [65 years of age (100,000 population)]. Treatment costs for managing both inpatient and outpatient cases of CAP were calculated from payments by the health plan. A total of 7,249 episodes of CAP among 6,415 individuals were identified. The hospitalization rate was 19.6%, and the mortality rate for those hospitalized was 9.1%. Patients requiring hospitalization were older and had more comorbid conditions. The mean (± SD) treatment cost for an inpatient episode of CAP (including all inpatient and outpatient medical care) was $10,227 ± 15,342. The costs for inpatients who died during hospitalization (mean cost, $15,822 ± 26,541) were higher than for episodes in which patients were discharged from the hospital alive (mean cost, $9,595 ± 13,641). The mean treatment cost for an outpatient episode of CAP was $466 ± 1,038. The treatment cost of managing CAP in this employed population was higher than previously estimated. It is estimated that the annual cost of treating CAP in the United States is $12.2 billion.