Healthcare utilization and cost of pneumococcal disease in the United States
Healthcare utilization and cost of pneumococcal disease in the United States
复制标题
DOI：
10.1016/j.vaccine.2011.02.088
复制
发表时间：
2011-04-18
期刊：
影响因子：
5.5
通讯作者：
Finkelstein, Jonathan A.
中科院分区：
文献类型：
--
作者：
Huang, Susan S.;Johnson, Kristen M.;Finkelstein, Jonathan A.
背景：肺炎链球菌继续引起各种常见的临床症状，尽管成人和儿童都有疫苗接种计划。美国肺炎链球菌疾病的总负担是未知的。方法：我们构建了一个基于决策树的模型来估计2004年美国的医疗保健利用和肺炎链球菌疾病的成本。数据来自2004-2005年全国(医院)动态医疗调查(门诊就诊、抗生素)和全国医院出院调查(住院率)，以及疾控中心监测数据。关于肺炎球菌引起的每个综合征的发病率、预期的健康结果和医疗保健利用的其他假设是从文献和专家意见得出的。医疗保健和时间成本使用2007美元。结果：我们估计，在2004年，肺炎球菌疾病导致400万起疾病发作、2.2万人死亡、44.5万人住院、77.4万次急诊、500万次门诊和410万张门诊抗生素处方。直接医疗费用总计35亿美元。肺炎(866,000例)占所有病例的22%，占肺炎球菌费用的72%。相比之下，急性中耳炎和鼻窦炎(各150万例)占病例的75%，但仅占直接医疗费用的16%。65岁的患者是最严重的病例，也是直接医疗费用的主要来源(每年的医疗费用为18亿美元)。在这个年龄段，肺炎导致24.2万人住院，140万住院日，19.4万次急诊科就诊，37.4万次门诊就诊，1.6万人死亡。然而，如果考虑到工作损失和生产率，在年轻工作的成年人(18-50岁)中，肺炎球菌疾病的成本几乎与65岁相当。结论：即使在儿科和成人常规接种疫苗的时代，肺炎球菌疾病仍然是发病率和死亡率的主要原因。有必要继续努力减少严重肺炎球菌疾病，特别是成人肺炎。(C)2011爱思唯尔有限公司。保留所有权利。
Background: Streptococcus pneumoniae continues to cause a variety of common clinical syndromes, despite vaccination programs for both adults and children. The total U.S. burden of pneumococcal disease is unknown.Methods: We constructed a decision tree-based model to estimate U.S. healthcare utilization and costs of pneumococcal disease in 2004. Data were obtained from the 2004-2005 National (Hospital) Ambulatory Medical Care Surveys (outpatient visits, antibiotics) and the National Hospital Discharge Survey (hospitalization rates), and CDC surveillance data. Other assumptions regarding the incidence of each syndrome due to pneumococcus, expected health outcomes, and healthcare utilization were derived from literature and expert opinion. Healthcare and time costs used 2007 dollars.Results: We estimate that, in 2004, pneumococcal disease caused 4.0 million illness episodes, 22,000 deaths, 445,000 hospitalizations, 774,000 emergency department visits, 5.0 million outpatient visits, and 4.1 million outpatient antibiotic prescriptions. Direct medical costs totaled $3.5 billion. Pneumonia (866,000 cases) accounted for 22% of all cases and 72% of pneumococcal costs. In contrast, acute otitis media and sinusitis (1.5 million cases each) comprised 75% of cases but only 16% of direct medical costs. Patients >= 65 years old, accounted for most serious cases and the majority of direct medical costs ($1.8 billion in healthcare costs annually). In this age group, pneumonia caused 242,000 hospitalizations, 1.4 million hospital days, 194,000 emergency department visits, 374,000 outpatient visits, and 16,000 deaths. However, if work loss and productivity are considered, the cost of pneumococcal disease among younger working adults (18-< 50) nearly equaled those >= 65.Conclusions: Pneumococcal disease remains a substantial cause of morbidity and mortality even in the era of routine pediatric and adult vaccination. Continued efforts are warranted to reduce serious pneumococcal disease, especially adult pneumonia. (C) 2011 Elsevier Ltd. All rights reserved.