Clinical Observation |

Economic Burden of Pneumonia in an Employed Population

Howard G. Birnbaum, PhD; Melissa Morley, MA; Paul E. Greenberg, MS, MA; Mary Cifaldi, RPh, MSHA; Gene L. Colice, MD
Arch Intern Med. 2001;161(22):2725-2731. doi:10.1001/archinte.161.22.2725.
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Objective  To estimate the overall economic burden of pneumonia from an employer perspective.

Methods  The annual, per capita cost of pneumonia was determined for beneficiaries of a major employer by analyzing medical, pharmaceutical, and disability claims data. The incremental costs of 4036 patients with a diagnosis of pneumonia identified in a health claims database of a national Fortune 100 company were compared with a 10% random sample of beneficiaries in the employer overall population.

Results  Total annual, per capita, employer costs were approximately 5 times higher for patients with pneumonia ($11 544) than among typical beneficiaries in the employer overall population ($2368). The increases in costs were for all components (eg, medical care, prescription drug, disability, and particularly for inpatient services). A small proportion (10%) of pneumonia patients (almost all of whom were hospitalized) accounted for most (59%) of the costs.

Conclusions  Patients with pneumonia present an important financial burden to employers. These patients use more medical care services, particularly inpatient services, than the average beneficiary in the employer overall population. In addition to direct health care costs related to medical utilization and the use of prescription drugs, indirect costs due to disability and absenteeism also contribute to the high cost of pneumonia to an employer.

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Figure 1.

Health claims per beneficiary, by type of service, 1997. "Other" includes care at patient's home, nursing or extended care facility, psychiatric day care facility, substance abuse treatment facility, and independent clinical laboratories.

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Figure 2.

Employer payments for treated pneumonia patients and employer overall population, by cost component, 1997. "Health care" includes inpatient, outpatient, office visits, prescription drugs, and other costs. Costs of absenteeism are imputed on the basis of days when medical care was provided. If an employee was not on disability when medical care occurred during normal work days, these days were counted as sickness work loss days in the case of hospital care or as a half-day in the case of office visits.

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Figure 3.

Employer payments for treated pneumonia patients and employer overall population, by type of condition, 1997. "Other respiratory conditions" include symptoms involving upper respiratory tract infection, acute upper respiratory infections of multiple or unspecified sites, acute tonsillitis and acute pharyngitis, acute bronchitis, acute sinusitis, chronic sinusitis, chronic bronchitis, streptococcal sore throat and scarlet fever, chronic pharyngitis and nasopharyngitis (including rhinitis), chronic diseases of tonsils and adenoids, pneumonia, acute nasopharyngitis (acute cold) and acute laryngitis, influenza, nasal polyps, chronic laryngitis and laryngotracheitis, allergic rhinitis, other diseases of the upper respiratory tract, emphysema, asthma, bronchiectasis, extrinsic allergic alveolitis, chronic airway obstruction, not elsewhere classified, pneumoconioses and other lung diseases caused by external agents, and other diseases of the respiratory system.

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Figure 4.

Distribution of 1997 employer payments, pneumonia patients vs employer overall population. Asterisks indicate the median payment. The horizontal lines of the box indicate the 25th and 75th percentiles of payments. The lower tail of each box indicates the 5th to 24th percentiles of payments. The upper tail on each box indicates the 76th to 95th percentiles of the payments. The highest and lowest 5% of payments are not presented here.

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