Prabhakaran Aslesh Ottapura, Amarchand Ritvik, Kanungo Suman, Rajkumar Prabu, Bhardwaj Sumit Dutt, Kumar Rakesh, Gopal Parameswaran Giridara, Kumar Cp Girish, Potdar Varsha, Chakrabarti Alok Kumar, Makkar Nisha, Manna Byomkesh, Gharpure Radhika, Choudhary Aashish, Dhakad Shivram, Choudekar Avinash, Lafond Kathryn E, Azziz-Baumgartner Eduardo, Ortega-Sanchez Ismael R, Saha Siddhartha, Krishnan Anand
Influenza Program, US Centers for Disease Control and Prevention, Delhi, India.
Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India.
BMJ Public Health. 2025 Jul 3;3(2):e001727. doi: 10.1136/bmjph-2024-001727. eCollection 2025.
Community-acquired pneumonia (CAP) is an important cause of hospitalisation among older adults. Assessing costs of CAP hospitalisation aids in economic evaluation of preventive interventions and guides policy decisions.
We estimated resource utilisation rates and costs from a societal perspective among adults aged >60 years admitted with CAP in eight public and eight private hospitals in four Indian cities (ie, National Capital Region-Delhi, Kolkata, Pune and Chennai) from December 2018 to March 2020. We interviewed patients, reviewed medical records and bills to estimate resources used, direct medical cost of diagnosis and treatment; direct non-medical cost of travel, lodging and food; and indirect cost of patients and caregivers' lost income from admission to discharge. Mean costs with SD by hospital type, age group, chronic condition, critical care (intensive care unit, ICU) and virus detection are presented in US dollars (US$). Linear regression after log transformation was conducted to identify determinants of total cost.
We analysed data from 1009 CAP patients in private (63%) and public (37%) hospitals with a median age of 68 (IQR: 63-75) years. Influenza was detected in 121 (12%) and respiratory syncytial virus (RSV) in 21 (2%). Mean length of stay was 6.2 (SD 4.8) days; 37% required ICU admission. Antibiotics and antivirals were used in 96% and 23% of admissions, respectively. Mean (SD) CAP hospitalisation cost was US$305 (244) in public and US$1210 (1019) in private hospitals; US$1024 (1095) in influenza and US$943 (778) in RSV-associated CAP. Regression analysis showed that cost was higher in hospitalisation in private hospitals, those requiring ICU care and among persons with comorbid conditions.
Substantial resources were used, and costs were incurred during CAP hospitalisation among older adults. The findings could aid in cost-benefit analyses of interventions to reduce pneumonia burden, including influenza, RSV or pneumococcal vaccination in older adults.
社区获得性肺炎（CAP）是老年人住院的重要原因。评估CAP住院费用有助于对预防干预措施进行经济评估，并为政策决策提供指导。
我们从社会角度估算了2018年12月至2020年3月期间在印度四个城市（即国家首都地区德里、加尔各答、浦那和金奈）的8家公立医院和8家私立医院中因CAP入院的60岁以上成年人的资源利用率和成本。我们采访了患者，查阅了病历和账单，以估算所使用的资源、诊断和治疗的直接医疗费用；交通、住宿和食品的直接非医疗费用；以及患者和护理人员从入院到出院的收入损失的间接费用。按医院类型、年龄组、慢性病、重症监护（重症监护病房，ICU）和病毒检测情况列出的平均费用及标准差以美元（$）表示。进行对数转换后的线性回归以确定总成本的决定因素。
我们分析了私立医院（63%）和公立医院（37%）中1009例CAP患者的数据，中位年龄为68岁（四分位间距：63 - 75岁）。121例（12%）检测出流感，21例（2%）检测出呼吸道合胞病毒（RSV）。平均住院时间为6.2天（标准差4.8天）；37%的患者需要入住ICU。分别有96%和23%的入院患者使用了抗生素和抗病毒药物。公立医院CAP平均住院费用为305美元（标准差244美元），私立医院为1210美元（标准差1019美元）；流感相关CAP为1024美元（标准差1095美元），RSV相关CAP为943美元（标准差778美元）。回归分析表明，私立医院、需要ICU护理的患者以及患有合并症的患者住院费用更高。
老年人CAP住院期间使用了大量资源并产生了费用。这些研究结果有助于对减轻肺炎负担的干预措施进行成本效益分析，包括老年人的流感、RSV或肺炎球菌疫苗接种。
