Mohanty Salini, Cossrow Nicole, White Meghan, Yu Kalvin C, Ye Gang, Feemster Kristen A, Gupta Vikas
Outcomes Research, Merck & Co., Inc, 126 East Lincoln Ave., P.O. Box 2000, Rahway, NJ, 07065, USA.
Becton, Dickinson & Company, Franklin Lakes, NJ, USA.
BMC Health Serv Res. 2024 Dec 18;24(1):1574. doi: 10.1186/s12913-024-11898-w.
Despite effective pneumococcal vaccines, pneumococcal disease (PD) exerts a substantial burden on children. This study explored the clinical and economic burden of invasive PD (IPD), non-invasive all-cause pneumonia (ACP), and acute otitis media (AOM) in hospitalized children.
Data from the BD Insights Research Database of hospitalized children (< 18 years, including infants and children) in the US were analyzed retrospectively. The study cohort included patients with an ICD10 code for IPD, ACP, or AOM and/or a positive culture for S. pneumoniae. Descriptive statistics and multivariable analyses evaluated the following outcomes: length of stay [LOS], hospital cost per admission, hospital margin per admission [costs - payments], and in-hospital mortality.
The study included 4575 pediatric patients with IPD (n = 36), ACP (n = 3,329), or AOM (n = 1,210) admitted to 57 US hospitals from October 2015 to February 2020. Approximately half (50.7%) were under 2 years of age. The in-hospital mortality rate was 0.6% (n = 28). The observed median (interquartile range) LOS was 4 (3, 5) days, cost per admission was $4,240 ($2,434, $8,311) US dollars, and hospital margin per admission was -$63 ($2,118, $2,025). LOS and costs were highly variable according to clinical characteristics and hospital variables. Key variables associated with poor outcomes were having a moderate- or high-risk condition (chronic or immunocompromising), intensive care unit admission, and prior 90-day admission.
The burden of PD among hospitalized pediatric patients in the US remains substantial. Our study highlights the burden of PD among young children (< 2 years) and children with underlying medical conditions that put them at greater risk for PD. The results support the need for ongoing prevention efforts including vaccination and antimicrobial stewardship programs to reduce the burden of PD in children.
尽管有有效的肺炎球菌疫苗，但肺炎球菌疾病（PD）仍给儿童带来沉重负担。本研究探讨了住院儿童侵袭性肺炎球菌疾病（IPD）、非侵袭性全因性肺炎（ACP）和急性中耳炎（AOM）的临床和经济负担。
对美国住院儿童（<18岁，包括婴儿和儿童）的BD Insights研究数据库中的数据进行回顾性分析。研究队列包括具有IPD、ACP或AOM的ICD10编码和/或肺炎链球菌培养阳性的患者。描述性统计和多变量分析评估了以下结果：住院时间[LOS]、每次入院的医院费用、每次入院的医院利润[费用-支付]和住院死亡率。
该研究纳入了2015年10月至2020年2月期间在美国57家医院住院的4575例患有IPD（n = 36）、ACP（n = 3329）或AOM（n = 1210）的儿科患者。大约一半（50.7%）为2岁以下儿童。住院死亡率为0.6%（n = 28）。观察到的中位（四分位间距）住院时间为4（3，5）天，每次入院费用为4240美元（2434美元，8311美元），每次入院的医院利润为-63美元（2118美元, 2025美元）。住院时间和费用根据临床特征和医院变量有很大差异。与不良结局相关的关键变量包括患有中度或高危疾病（慢性或免疫功能低下）、入住重症监护病房和90天内曾入院。
美国住院儿科患者中肺炎球菌疾病的负担仍然很大。我们的研究强调了2岁以下幼儿和有潜在疾病使其患肺炎球菌疾病风险更高的儿童中肺炎球菌疾病的负担。结果支持需要持续开展预防工作，包括疫苗接种和抗菌药物管理计划，以减轻儿童肺炎球菌疾病的负担。
