Niederman M S, McCombs J S, Unger A N, Kumar A, Popovian R
Winthrop-University Hospital, Mineola, New York 11501, USA.
Clin Ther. 1998 Jul-Aug;20(4):820-37. doi: 10.1016/s0149-2918(98)80144-6.
Community-acquired pneumonia (CAP) is responsible for an average of 4.5 million visits annually to physicians' offices, emergency departments, and outpatient clinics. However, there have been few studies using national data on the costs of treating CAP. Without such data, it is difficult to assess whether new therapies and treatment strategies are needed to improve patient outcomes. We conducted a retrospective analysis based on national incidence data and paid claims data for patients treated for CAP to assess the frequency of services rendered and costs to the health-care system. Records were selected for the study based on a primary diagnosis of CAP according to the International Classification of Diseases, 9th Revision. Incidence data were derived from the National Health and Nutrition Examination Survey III. Medicare was the primary source of data for patients aged > or =65 years. Data from the National Healthcare Cost and Utilization Project, the National Ambulatory Medical Care Survey, and the National Hospital Ambulatory Medical Care Survey were used to determine the cost of treating patients aged <65 years. We arrived at a total cost of $4.8 billion for treating patients aged > or =65 years and $3.6 billion for treating patients aged <65 years. These calculations were based on the following: 1.1 million hospital discharges resulting in inpatient costs of $4.4 billion (52.4% of the $8.4 billion) for the 0.6 million patients aged > or =65 years and $3.1 billion (36.9% of the $8.4 billion) for the 0.5 million patients aged <65 years. The average hospital length of stay was 7.8 days with an average cost of $7166 for patients aged > or =65 years and 5.8 days with an average cost of $6042 for younger patients. Room and board represented the largest percentage of the average hospital bill for patients with CAP. Inpatient physician service costs were $305 million and $192 million for the > or =65 and <65 groups, respectively. Based on 1.1 million outpatient office visits for those aged > or =65 years and 3.3 million visits for those aged <65, total outpatient costs were $119 million and $266 million, respectively. Given the overwhelming cost burden for CAP in the hospital setting, any new therapy that allows patients to be treated in the outpatient setting could result in significant savings, especially for patients aged > or =65 years.
社区获得性肺炎（CAP）每年平均导致450万人次前往医生办公室、急诊科和门诊诊所就诊。然而，利用全国性数据研究CAP治疗成本的研究很少。没有此类数据，就难以评估是否需要新的治疗方法和治疗策略来改善患者预后。我们基于全国发病率数据和CAP治疗患者的付费索赔数据进行了一项回顾性分析，以评估所提供服务的频率和医疗系统的成本。根据国际疾病分类第九版，将主要诊断为CAP的记录选入研究。发病率数据来自第三次全国健康和营养检查调查。医疗保险是65岁及以上患者数据的主要来源。来自国家医疗保健成本和利用项目、国家门诊医疗调查和国家医院门诊医疗调查的数据用于确定65岁以下患者的治疗成本。我们得出，65岁及以上患者的治疗总成本为48亿美元，65岁以下患者的治疗总成本为36亿美元。这些计算基于以下数据：110万例住院出院病例，其中60万例65岁及以上患者的住院费用为44亿美元（占84亿美元的52.4%），50万例65岁以下患者的住院费用为31亿美元（占84亿美元的36.9%）。65岁及以上患者的平均住院天数为7.8天，平均费用为7166美元；年轻患者的平均住院天数为5.8天，平均费用为6042美元。食宿费用在CAP患者的平均住院账单中占比最大。65岁及以上组和65岁以下组的住院医生服务费用分别为3.05亿美元和1.92亿美元。基于65岁及以上患者110万次门诊就诊和65岁以下患者330万次门诊就诊，门诊总费用分别为1.19亿美元和2.66亿美元。鉴于CAP在医院环境中造成的巨大成本负担，任何能够让患者在门诊接受治疗的新疗法都可能带来显著的成本节约，尤其是对于65岁及以上的患者。
