美国肺炎球菌病的医疗利用和费用。

Healthcare utilization and cost of pneumococcal disease in the United States.

机构信息

Division of Infectious Diseases and Health Policy Research Institute, University California Irvine School of Medicine, 100 Theory Ave, Suite 110, Irvine, CA 92697, USA.

出版信息

Vaccine. 2011 Apr 18;29(18):3398-412. doi: 10.1016/j.vaccine.2011.02.088. Epub 2011 Mar 11.

DOI:10.1016/j.vaccine.2011.02.088

PMID:21397721

Abstract

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.

摘要

背景

尽管已经开展了针对成人和儿童的肺炎球菌疫苗接种计划，但肺炎球菌仍会引起多种常见临床综合征。美国整体肺炎球菌疾病负担尚不清楚。

方法

我们构建了一个基于决策树的模型，用于估计 2004 年美国肺炎球菌疾病的医疗保健利用和成本。数据来自 2004-2005 年全国（医院）门诊医疗保健调查（门诊就诊、抗生素使用）和全国医院出院调查（住院率），以及疾病预防控制中心的监测数据。关于每种综合征因肺炎球菌导致的发病率、预期健康结果和医疗保健利用的其他假设，源自文献和专家意见。医疗保健和时间成本采用 2007 年美元计价。

结果

我们估计，2004 年，肺炎球菌疾病导致 400 万例疾病发作、22000 例死亡、445000 例住院、774000 例急诊就诊、500 万例门诊就诊和 410 万例门诊抗生素处方。直接医疗费用总计 35 亿美元。肺炎（866000 例）占所有病例的 22%和肺炎球菌疾病成本的 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 岁的患者占严重病例的大多数，也是直接医疗费用的主要承担者（每年医疗费用为 18 亿美元）。在该年龄组中，肺炎导致 242000 例住院、140 万住院日、194000 例急诊就诊、374000 例门诊就诊和 16000 例死亡。然而，如果考虑工作损失和生产力，年轻工作成年人（18-<50 岁）的肺炎球菌疾病成本几乎与≥65 岁人群相当。