National Costs of Inpatient Pneumonia Care Among U.S. Adults from 2001-2012

Introduction: Limited national U.S. data describe the epidemiology of inpatient pneumonia care, particularly with regards to cost.

Objectives: To describe current, national trends for the cost of adult, inpatient pneumonia care. 

Study Design: Cost trend study using data from the 2001-2012 releases of the National Inpatient Sample (NIS) database from the Agency for Healthcare Research and Quality's (AHRQ), Healthcare Cost and Utilization Project (HCUP). 

Methods: We extracted cases of adults hospitalized with pneumonia in the U.S. from 2001-2012. Patients <18 years of age were excluded. We defined cases of pneumonia using ICD-9 codes into two groups: cases with a principal discharge diagnosis (PDD) of pneumonia, and cases with a PDD of sepsis or respiratory failure plus a secondary discharge diagnosis of pneumonia. Costs were adjusted to 2012 U.S. dollars using the medical consumer price index to account for inflation over time. Data weights were used to provide national estimates.

Results: We identified nearly 15.3 million cases of inpatient pneumonia from 2001-2012. Median age was 72 years (interquartile range [IQR], 58-82), 47.3% were male, and 60% were Caucasian. From 2001-2012, the average annual cost of care in the U.S. was $16.6 billion, increasing from $12.1 billion in 2001 to $19 billion in 2012. The cost per pneumonia hospitalization has increased from $10,632 in 2001 to $14,239 in 2012. The mean annual cost to care for pneumonia cases with a PDD of pneumonia is substantially less than cases with a PDD of sepsis or respiratory failure ($9,714 vs. $24,534). Over the study period, the percentage of hospitalized pneumonia patients with a PDD of sepsis or respiratory failure has steadily increased from 11.2% in 2001 to 34.6% in 2012. 

Conclusions: Costs of adult, inpatient pneumonia care increased from 2001-2012, which may be due to an increased proportion of cases with a PDD of sepsis or respiratory failure.