Merck & Co., Inc, 126 East Lincoln Ave, P.O. Box 2000, Rahway, NJ, 07065, USA.
Analysis Group, Inc, Boston, MA, USA.
BMC Health Serv Res. 2023 Apr 25;23(1):398. doi: 10.1186/s12913-023-09244-7.
Streptococcus pneumoniae remains a leading cause of morbidity, mortality, and healthcare resource utilization (HRU) among children. This study quantified HRU and cost of acute otitis media (AOM), pneumonia, and invasive pneumococcal disease (IPD).
The IBM MarketScan® Commercial Claims and Encounters and Multi-State Medicaid databases from 2014 to 2018 were analyzed. Children with AOM, all-cause pneumonia, or IPD episodes were identified using diagnosis codes in inpatient and outpatient claims. HRU and costs were described for each condition in the commercial and Medicaid-insured populations. National estimates of the number of episodes and total cost ($US 2019 for each condition were extrapolated using data from the US Census Bureau.
Approximately 6.2 and 5.6 million AOM episodes were identified in commercial and Medicaid-insured children, respectively, during the study period. Mean cost per AOM episode was $329 (SD $1505) for commercial and $184 (SD $1524) for Medicaid-insured children. A total of 619,876 and 531,095 all-cause pneumonia cases were identified among commercial and Medicaid-insured children, respectively. Mean cost per all-cause pneumonia episode was $2304 (SD $32,309) in the commercial and $1682 (SD $19,282) in the Medicaid-insured population. A total of 858 and 1130 IPD episodes were identified among commercial and Medicaid-insured children, respectively. Mean cost per IPD episode was $53,213 (SD $159,904) for commercial and $23,482 (SD $86,209) for the Medicaid-insured population. Nationally, there were over 15.8 million cases of AOM annually, with total estimated cost of $4.3 billion, over 1.5 million cases of pneumonia annually, with total cost of $3.6 billion, and about 2200 IPD episodes annually, for a cost of $98 million.
The economic burden of AOM, pneumonia, and IPD among US children remains substantial. IPD and its manifestations were associated with higher HRU and costs per episode, compared to AOM and all-cause pneumonia. However, owing to their higher frequencies, AOM and all-cause pneumonia were the main contributors to the economic burden of pneumococcal disease nationally. Additional interventions, such as the development of pneumococcal conjugate vaccinees with sustained protection of existing vaccine type serotypes as well as broader inclusion of additional serotypes, are necessary to further reduce the burden of disease caused by these manifestations.
肺炎链球菌仍然是导致儿童发病率、死亡率和医疗资源利用（HRU）的主要原因。本研究量化了急性中耳炎（AOM）、肺炎和侵袭性肺炎球菌病（IPD）的 HRU 和成本。
分析了 2014 年至 2018 年的 IBM MarketScan®商业索赔和遭遇以及多州医疗补助数据库。使用住院和门诊索赔中的诊断代码，确定患有 AOM、各种原因肺炎或 IPD 发作的儿童。在商业和医疗补助保险人群中，描述了每种疾病的 HRU 和成本。使用美国人口普查局的数据推断出每种疾病的发作次数和总成本（2019 年 2019 美元）的全国估计数。
在研究期间，商业和医疗补助保险的儿童中分别确定了约 620 万和 560 万 AOM 发作。商业保险中每例 AOM 发作的平均费用为 329 美元（SD 1505 美元），而医疗补助保险中每例 AOM 发作的平均费用为 184 美元（SD 1524 美元）。商业和医疗补助保险的儿童中分别确定了 619876 例和 531095 例各种原因肺炎病例。商业保险中每例所有原因肺炎发作的平均费用为 2304 美元（SD 32309 美元），医疗补助保险中为 1682 美元（SD 19282 美元）。商业和医疗补助保险的儿童中分别确定了 858 例和 1130 例 IPD 发作。商业保险中每例 IPD 发作的平均费用为 53213 美元（SD 159904 美元），而医疗补助保险中每例 IPD 发作的平均费用为 23482 美元（SD 86209 美元）。全国每年有超过 1580 万例 AOM 病例，估计总费用为 43 亿美元，每年有超过 150 万例肺炎病例，总费用为 36 亿美元，每年约有 2200 例 IPD 病例，费用为 9800 万美元。
美国儿童的 AOM、肺炎和 IPD 的经济负担仍然很大。与 AOM 和各种原因肺炎相比，IPD 及其表现与更高的 HRU 和每个病例的成本相关。然而，由于它们的发病率更高，AOM 和各种原因肺炎是全国范围内肺炎球菌疾病经济负担的主要原因。需要进一步的干预措施，例如开发具有持续保护现有疫苗类型血清型的肺炎球菌结合疫苗以及更广泛地纳入其他血清型，以进一步降低这些表现引起的疾病负担。
