• An econometric model for patients hospitalized with community-acquired pneumonia

      Merchant, Sanjay Vijay; Mullins, C. Daniel (2001)
      Pneumonia is the leading cause of death due to an infectious disease in the US. The total cost of treating this disease is estimated at 23 billion dollars, including indirect costs. Hospitalization accounts for a majority of the total cost of treating pneumonia. Although studies in the past have provided national estimates of Community-Acquired Pneumonia (CAP) costs, most of them have failed to evaluate the impact of individual factors, such as severity of illness, mortality, Intensive Care Unit (ICU) admission, triaging and treatment decisions, on costs. The current study evaluated such factors, using econometric modeling. The study also evaluated differences in costs between patients who were treated according to guidelines and patients who were not. Claims data were acquired from three managed care plans in the Baltimore-Washington D.C. area. Clinical data were collected through medical chart abstraction. The claims and clinical data were merged using member identification and admission date. A total of 569 patients were included in the analyses. ICU admission increased the total cost of hospitalization. Patients who died had lower costs compared to patients who survived, primarily because patients who died had shorter hospital stays. As expected, the perdiem cost of patients who died was higher than that of patients who survived, suggesting that patients who died were indeed severely ill. Among the less severe and the moderately severe CAP patients, those who were treated according to guidelines cost less than patients who were not. The number of severely ill CAP patients treated according to guidelines was too small to determine the impact of such patients on cost. These results suggest that managed care plans should follow a more consistent approach, such as the use of guidelines, to triage patients (which will minimize unnecessary ICU stay and lead to cost reduction), and to select drug therapy for patients (which may lead to cost reduction), for the less severe and moderately severe CAP patients. Based on the low use of guidelines in severely ill patients, managed care plans should consider modifying the guidelines for the severely ill to enhance the applicability of guidelines in these patients.