Averin Ahuva, Weycker Derek, Lapidot Rotem, Rozenbaum Mark H, Huang Liping, Vietri Jeffrey, Arguedas Mohs Adriano, Cane Alejandro, Lonshteyn Alexander, Pelton Stephen I
Avalere Health, Boston, Massachusetts, USA.
Boston Medical Center, Boston, Massachusetts, USA.
J Med Econ. 2025 Dec;28(1):517-523. doi: 10.1080/13696998.2025.2484919. Epub 2025 Apr 3.
Invasive pneumococcal disease (IPD), pneumonia (PNE), and otitis media (OM) are significant causes of morbidity among children in the United States (US). While studies have evaluated the economic burden of these conditions, recent data on episodic costs of IPD, PNE, and OM requiring hospitalization or ambulatory care only among US children by age and comorbidity profile are currently not available. This study was undertaken to address this evidence gap.
A retrospective observational cohort design and data (2015-2019) from Optum's de-identified Clinformatics Data Mart Database were employed. Episodes of IPD, all-cause PNE, and all-cause OM were ascertained on a monthly basis during the follow-up period and stratified by care setting (hospital vs. ambulatory); all-cause OM was alternatively stratified by disease severity (acute, persistent, tympanostomy tube placement) and, for acute/persistent, by complexity (simple, complex). Mean episodic costs of disease were estimated for children aged <1, 1-<2, 2-<6, and 6-<18 years, respectively, overall and by comorbidity profile (with vs. without ≥1 medical condition).
Mean age-specific cost of IPD hospitalization ranged from $40,575-$95,607; IPD requiring care in an emergency department (ED), from $2,013-$5,606; and IPD requiring care in other ambulatory settings, from $619-$1,103. Mean cost of all-cause PNE ranged from $16,631-$21,429 for hospitalized cases; $2,462-$2,685 for ED cases; and $424-$473 for other ambulatory cases. Corresponding ranges for all-cause OM were $14,599-$16,341; $1,190-$2,083; and $253-$514. Children with (vs. without) comorbidities had higher mean costs of PNE episodes across all ages and care settings; mean cost of all-cause OM was largely invariant by comorbidity profile and was highest for episodes involving TTP.
Costs of IPD, all-cause PNE, and all-cause OM are high, particularly in the hospital setting. All-cause PNE, one of the most common causes of hospitalization for children, is particularly costly for children with comorbidities.
侵袭性肺炎球菌疾病（IPD）、肺炎（PNE）和中耳炎（OM）是美国儿童发病的重要原因。虽然已有研究评估了这些疾病的经济负担，但目前尚无关于美国儿童中仅需住院治疗或门诊治疗的IPD、PNE和OM按年龄和合并症情况划分的单次发作成本的最新数据。本研究旨在填补这一证据空白。
采用回顾性观察队列设计，并使用了Optum公司去识别化的临床信息数据集市数据库中的数据（2015 - 2019年）。在随访期间每月确定IPD、全因性PNE和全因性OM的发作情况，并按护理环境（住院与门诊）进行分层；全因性OM也可按疾病严重程度（急性、持续性、鼓膜置管）分层，对于急性/持续性OM，还可按复杂性（简单、复杂）分层。分别估算了年龄小于1岁、1 - 2岁、2 - 6岁和6 - 18岁儿童疾病的平均单次发作成本，总体情况以及按合并症情况（有≥1种疾病与无疾病）进行估算。
IPD住院的特定年龄平均成本在40,575美元至95,607美元之间；在急诊科（ED）接受治疗的IPD，成本在2,013美元至5,606美元之间；在其他门诊环境接受治疗的IPD，成本在619美元至1,103美元之间。全因性PNE住院病例的平均成本在16,631美元至21,429美元之间；急诊科病例的成本在2,462美元至2,685美元之间；其他门诊病例的成本在424美元至473美元之间。全因性OM的相应成本范围分别为14,599美元至16,341美元；1,190美元至2,083美元；253美元至514美元。患有合并症（与无合并症相比）的儿童在所有年龄和护理环境下PNE发作的平均成本更高；全因性OM的平均成本在很大程度上不受合并症情况的影响，且涉及鼓膜置管的发作成本最高。
IPD、全因性PNE和全因性OM的成本很高，尤其是在医院环境中。全因性PNE是儿童住院的最常见原因之一，对于患有合并症的儿童来说成本尤其高昂。
