Clinical and economic burden of community-acquired pneumonia in the Medicare fee-for-service population

J Am Geriatr Soc. 2012 Nov;60(11):2137-43. doi: 10.1111/j.1532-5415.2012.04208.x. Epub 2012 Oct 30.


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 (before-after) and with matched controls (case-control).

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Community-Acquired Infections / economics*
  • Cost of Illness*
  • Fee-for-Service Plans / economics*
  • Female
  • Humans
  • Male
  • Medicare / economics*
  • Middle Aged
  • Pneumonia / economics*
  • Pneumonia / epidemiology*
  • Retrospective Studies
  • United States
  • Young Adult