Clinical and Economic Burden of Community-Acquired Pneumonia in the Medicare Fee-for-Service Population

Objectives To estimate current community-acquired pneumonia (CAP) incidence and its associated economic burden in the Medicare fee-for-service (FFS) population. Design Retrospective. Setting The 2007/08 Medicare Standard Analytic Files, a nationally representative random sample (5%) of Medicare beneficiaries enrolled in the FFS program. Participants Residents of one of the 50 U.S. states or the District of Columbia aged 18 and older on July 1, 2007, with continuous Part A and Part B coverage during calendar year 2007. Measurements Incidence, episode length, mortality, and costs were assessed. All-cause costs were assessed using three methodologies: costs during the episode, and incremental costs using CAP cases as self-control (beforeafter) and with matched controls (casecontrol). Results Sixty-five thousand eight hundred four CAP episodes (39% inpatient-treated episodes) were identified. Average inpatient and outpatient episode lengths were 32.8 +/- 46.9 and 12.4 +/- 27.3 days, respectively, and overall incidence was 4,482/100,000 person-years. Thirty-day case fatality was 8.5% for inpatient and 3.8% for outpatient CAP. The average CAP episode cost was $8,606 ($18,670 for inpatient, $2,394 for outpatient). The incremental cost of a CAP episode in the before-and-after and case-control analyses was approximately $10,000. Conclusion An estimated 1.3 million CAP cases and 74,000 CAP-related deaths were found, with an economic burden of $13 billion annually in the Medicare fee-for-service population. Preventing CAP in this population may substantially reduce healthcare costs. J Am Geriatr Soc 60: 2137-2143, 2012.