Attributable Cost of Adult Hospitalized Pneumonia Beyond the Acute Phase

BACKGROUND: While much is known about the cost of community-acquired pneumonia (CAP) during the acute phase of illness, little is known about the potential attributable cost of CAP thereafter. OBJECTIVE: The aim of this study was to assess long-term attributable costs associated with CAP among adults in US clinical practice. METHODS: A retrospective matched cohort design and data from a US private healthcare claims repository were employed. In each month during the study period (2011–2016), adults who were hospitalized for CAP in that month (‘CAP patients’) were matched (1:1, without replacement) on demographic, clinical, and healthcare profiles to adults who did not develop CAP in that month (‘comparison patients’). All-cause healthcare expenditures were tallied for the qualifying CAP hospitalization and during the 30-day period post-discharge (collectively, ‘acute phase’), as well as from the end of the acute phase to the end of the 3-year follow-up period (‘long-term phase’). RESULTS: The study population included 43,975 matched pairs of CAP patients and comparison patients. Expenditures averaged $33,380 (95% confidence interval [CI] $32,665–$34,161) for the CAP hospitalization and $4568 (95% CI $4385–$4749) during the 30-day period thereafter (vs. $2075 [95% CI $1989–$2167] in total for the comparison patients). During the long-term phase, all-cause expenditures averaged $83,463 (95% CI $81,318–$85,784) for CAP patients versus $51,017 (95% CI $49,553–$52,491) for comparison patients, and thus attributable expenditures during this phase totaled $32,446 (95% CI $29,847–$35,075). The majority of attributable CAP expenditures (53% of $68,319) occurred during the acute phase, while 21%, 14%, and 12% occurred during the first, second, and third years, respectively, after the acute phase. CONCLUSIONS: Our findings provide additional evidence that the cost of CAP requiring hospitalization is high, and that the impact of CAP extends well beyond the expected time for resolution of acute inflammatory signs. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s41669-020-00240-9) contains supplementary material, which is available to authorized users.