People with certain chronic medical conditions represent a disproportionately large part of all invasive pneumococcal disease and pneumonia cases, with high associated care costs. Particularly, individuals with asthma and diabetes are at high risk, despite widespread pneumococcal vaccination programs.
The higher risk for pneumococcal disease in patients with certain medical conditions is well known, but until now, there has been no comprehensive analyses of cost for care of pneumococcal pneumonia.
Researchers at Pfizer teamed up with Policy Analysis, a company in Massachusetts, to perform an analysis of rates and associated costs of invasive pneumococcal disease and all-cause pneumonia using data from three healthcare claims databases, including both medical in- and outpatient claims, as well as outpatient pharmacy claims.
Even though pneumococcal disease was the main point of study, the research team included all-cause pneumonia as a measure since pneumococcal pneumonia is known to be under-reported in healthcare claims. Although about 30 percent of all pneumonia cases are estimated to be caused by the pneumococcal bacterium Streptococcus pneumoniae, the microbe might be difficult to culture in clinical practice, preventing a diagnosis.
Individuals in the study were divided into three age groups (0-17, 18-64, and 65 years and older), as well as three groups depending on their risk (healthy, at-risk, and high-risk). A patient could only belong to one of the at-risk and high-risk groups.
The at-risk group included all individuals who currently are recommended to get vaccinated against pneumococcal disease, as well as patients with asthma, chronic steroid use, trisomy 21, premature birth or low birth weight, neuromuscular or seizure disorders, rheumatoid arthritis, systemic lupus erythematosis, and Crohn’s disease.
Individuals with these conditions were stratified according to the number of conditions, and patients with asthma or diabetes were also graded according to disease severity.
The high-risk group contained people who were immunocompromised, immunosuppressed, or had a cochlear implant.
The study “Rates and costs of invasive pneumococcal disease and pneumonia in persons with underlying medical conditions,“ found that people who had two or more at-risk conditions, asthma or diabetes, had a particularly high risk for pneumococcal disease or pneumonia.
Although the high-risk group constituted only about 4 percent of the whole group assessed, they represented 18 percent of the pneumococcal disease or pneumonia cases, and accounted for 30 percent of the total care cost. Likewise, those with two or more at-risk conditions, composing 3 percent of the study population, accounted for 21 percent of the costs.
Moreover, the analyses, published in the journal BMC Health Services Research, showed that costs in people with asthma or diabetes increased proportionally with the severity of disease.
The study, while holding a number of limitations, such as a likely underestimation of invasive pneumococcal disease and the lack of representation of people with public or no health insurance, indicates that more interventions targeting specific groups might be necessary to harness the development and associated costs of pneumococcal disease.