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      Clinical and Economic Burden of Community-Acquired Pneumonia among Adults in the Czech Republic, Hungary, Poland and Slovakia

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          Abstract

          We estimate and describe the incidence rates, mortality, and cost of CAP (community-acquired pneumonia), in both inpatient and outpatient settings, in the Czech Republic (CZ), Slovakia (SK), Poland (PL), and Hungary (HU). A retrospective analysis was conducted on administrative data from the health ministry and insurance reimbursement claims with a primary diagnosis of pneumonia in 2009 to determine hospitalization rates, costs, and mortality in adults ≥50 years of age. Patient chart reviews were conducted to estimate the number of outpatient cases. Among all adults ≥50 years, the incidence of hospitalized CAP per 100,000 person years was: 456.6 (CZ), 504.6 (SK), 363.9 (PL), and 845.3 (HU). The average fatality rate for all adults ≥50 is 19.1%, and for each country; 21.7% (CZ), 20.9% (SK), 18.6% (PL), 17.8% (HU). Incidence, fatality, and likelihood of hospitalization increased with advancing age. Total healthcare costs of CAP in EUR was 12,579,543 (CZ); 9,160,774 (SK); 22,409,085 (PL); and 18,298,449 (HU); with hospitalization representing over 90% of the direct costs of treatment. The burden of CAP increases with advancing age in four CEE countries, with hospitalizations driving the costs of CAP upwards in the elderly population. Mortality rates are generally higher than reported in Western EU countries.

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          Clinical and economic burden of community-acquired pneumonia among adults in Europe.

          It is difficult to determine the impact of community-acquired pneumonia (CAP) in Europe, because precise data are scarce. Mortality attributable to CAP varies widely between European countries and with the site of patient management. This review analysed the clinical and economic burden, aetiology and resistance patterns of CAP in European adults. All primary articles reporting studies in Europe published from January 1990 to December 2007 addressing the clinical and economic burden of CAP in adults were included. A total of 2606 records were used to identify primary studies. CAP incidence varied by country, age and gender, and was higher in individuals aged ≥65 years and in men. Streptococcus pneumoniae was the most common agent isolated. Mortality varied from <1% to 48% and was associated with advanced age, co-morbid conditions and CAP severity. Antibiotic resistance was seen in all pathogens associated with CAP. There was an increase in antibiotic-resistant strains, but resistance was not related to mortality. CAP was associated with high rates of hospitalisation and length of hospital stay. The review showed that the clinical and economic burden of CAP in Europe is high. CAP has considerable long-term effects on quality of life, and long-term prognosis is worse in patients with pneumococcal pneumonia.
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            Hospitalized community-acquired pneumonia in the elderly: age- and sex-related patterns of care and outcome in the United States.

            Community-acquired pneumonia (CAP) is a frequent cause of hospital admission and death among elderly patients, but there is little information on age- and sex-specific incidence, patterns of care (intensive care unit admission and mechanical ventilation), resource use (length of stay and hospital costs), and outcome (mortality). We conducted an observational cohort study of all Medicare recipients, aged 65 years or older, hospitalized in nonfederal U.S. hospitals in 1997, who met ICD-9-CM-based criteria for CAP. We identified 623,718 hospital admissions for CAP (18.3 per 1,000 population > or = 65 years), of which 26,476 (4.3%) were from nursing homes and of which 66,045 (10.6%) died. The incidence rose five-fold and mortality doubled as age increased from 65-69 to older than 90 years. Men had a higher mortality, both unadjusted (odds ratio [OR]: 1.21 [95% CI: 1.19-1.23]) and adjusted for age, location before admission, underlying comorbidity, and microbiologic etiology (OR: 1.15 [95% CI: 1.13-1.17]). Mean hospital length of stay and costs per hospital admission were 7.6 days and $6,949. For those admitted to the intensive care unit (22.4%) and for those receiving mechanical ventilation (7.2%), mean length of stay and costs were 11.3 days and $14,294, and 15.7 days and $23,961, respectively. Overall hospital costs were $4.4 billion (6.3% of the expenditure in the elderly for acute hospital care), of which $2.1 billion was incurred by cases managed in intensive care units. We conclude that in the hospitalized elderly, CAP is a common and frequently fatal disease that often requires intensive care unit admission and mechanical ventilation and consumes considerable health care resources. The sex differences are of concern and require further investigation.
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              New perspectives on community-acquired pneumonia in 388 406 patients. Results from a nationwide mandatory performance measurement programme in healthcare quality

              Background: The database of the German programme for quality in healthcare including data of every hospitalised patient with community-acquired pneumonia (CAP) during a 2-year period (n = 388 406 patients in 2005 and 2006) was analysed. Methods: End points of the analysis were: (1) incidence; (2) outcome; (3) performance of the CRB-65 (C, mental confusion; R, respiratory rate ⩾30/min; B, systolic blood pressure <90 mm Hg or diastolic blood pressure ⩽60 mm Hg; 65, age ⩾65 years) score in predicting death; and (4) lack of ventilatory support as a possible indicator of treatment restrictions. The CRB-65 score was calculated, resulting in three risk classes (RCs). Results: The incidence of hospitalised CAP was 2.75 and 2.96 per 1000 inhabitants/year in 2005 and 2006, respectively, higher for males (3.21 vs 2.52), and strongly age related, with an incidence of 7.65 per 1000 inhabitants/year in patients aged ⩾60 years over 2 years. Mortality (13.72% and 14.44%) was higher than reported in previous studies. The CRB-65 RCs accurately predicted death in a three-class pattern (mortality 2.40% in CRB-65 RC 1, 13.43% in CRB-65 RC 2 and 34.39% in CRB-65 RC 3). The first days after admission were consistently associated with the highest risk of death throughout all risk classes. Only a minority of patients who died had received mechanical ventilation during hospitalisation (15.74%). Conclusions: Hospitalised CAP basically is a condition of the elderly associated with a higher mortality than previously reported. It bears a considerable risk of early mortality, even in low risk patients. CRB-65 is a simple and powerful tool for the assessment of CAP severity. Hospitalised CAP is a frequent terminal event in chronic debilitated patients, and a limitation of treatment escalation is frequently applied.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2013
                6 August 2013
                : 8
                : 8
                : e71375
                Affiliations
                [1 ]CEEOR spol. s r.o., Prague, Czech Republic
                [2 ]Emerging Markets Business Unit, Pfizer Inc., Collegeville, Pennsylvania, United States of America
                [3 ]Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
                [4 ]Department of Immunology & Allergology, Military Institute of Health Service, Warsaw, Poland
                [5 ]University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
                [6 ]I. Department of Pneumology and Ftizeology, National Institute for Tuberculosis, Lung Diseases and Thoracic Surgery, Vysne Hagy, Slovakia
                [7 ]Department of Pulmonary Diseases and Tuberculosis, University Hospital Olomouc, Olomouc, Czech Republic
                Health Protection Agency, United Kingdom
                Author notes

                Competing Interests: The authors have the following interests. This study was sponsored by Pfizer Inc. CR and PH are employees and shareholders in Pfizer Inc. AT and IG are employed by CEEOR spol. s r.o. AT and IG have received a reimbursement for attending a symposium, a fee for speaking and funds for research; AS received a reimbursement for attending a symposium, a fee for speaking, a fee for organizing education, funds for research, funds for a member of staff and fees for consulting; VH has received a reimbursement for attending a symposium, a fee for speaking and fees for consulting. PR has received a reimbursement for attending a symposium, a fee for speaking, and fees for consulting and funds for research from Pfizer Inc. in the past five years. KJH has served as a principal investigator in clinical trials (A7881013, A6631029) sponsored by Pfizer Inc. in the past five years. VK has no conflict of interest. Pfizer Inc. develops and markets medicines and vaccines for the treatment and prevention of pneumonia. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.

                Conceived and designed the experiments: AT CR IG PH. Performed the experiments: AT VK IG. Analyzed the data: AT IG. Contributed reagents/materials/analysis tools: AS WH KJR RP IS VK. Wrote the paper: AT CR.

                Article
                PONE-D-12-38607
                10.1371/journal.pone.0071375
                3735497
                23940743
                1a1f344c-1c6c-4894-8c48-8941d25c257f
                Copyright @ 2013

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 6 December 2012
                : 4 July 2013
                Page count
                Pages: 7
                Funding
                This study was sponsored by Pfizer Inc. CR and PH are co-authors of the manuscript. The funders had no role in study design, data collection and analysis; they, however, revised and authorized the manuscript for publishing.
                Categories
                Research Article
                Medicine
                Epidemiology
                Disease Informatics
                Economic Epidemiology
                Epidemiological Methods
                Infectious Disease Epidemiology
                Pharmacoepidemiology
                Social Epidemiology
                Survey Methods
                Infectious Diseases
                Non-Clinical Medicine
                Health Economics
                Cost Effectiveness
                Socioeconomic Aspects of Health

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                Uncategorized

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