Hospital cost of invasive pneumococcal disease in children aged under 15 years old in Tunisia.

BACKGROUND: Pneumococcal infections are an important cause of morbidity and mortality in the world and in Tunisia. Data on the economic burden of these infections are needed to inform decision-making to include pneumococcal vaccinations in routine childhood immunization. AIMS: This study aimed to estimate the medical cost of hospitalizations due to invasive pneumococcal disease (pneumonia and meningitis) among children aged under 15 years old in Tunisia. METHODS: A prospective multicentre study was conducted in 15 paediatric departments, across different socio-economic areas of Tunisia, from June 2014 to May 2015. All children aged under 15 years old who were hospitalized for pneumococcal pneumonia or confirmed bacterial meningitis were enrolled. A case report form was completed for every eligible case. Activity Based Costing method was used to estimate the hospital cost. Data entry and statistical analysis were conducted using SPSS, version 20.0. RESULTS: During the study period, 727 children were hospitalized for pneumococcal pneumonia and 60 children were hospitalized for bacterial meningitis, among them 21(35%) had confirmed pneumococcal meningitis. The median hospital cost for pneumococcal pneumonia was 353.910 Tunisian Dinars (TND) and TND 1680.632 for pneumococcal meningitis. Using overall data extrapolation, it was estimated that nearly 1091 hospitalizations for pneumococcal pneumonia and 69 hospitalizations for pneumococcal meningitis occurred each year in Tunisian children aged under 15 years of age, incurring total costs of TND 502 079.408. CONCLUSION: The economic burden of pneumococcal infections seems to be substantial in Tunisia. The estimated costs does not reflect the real costs of this infection. Cost-effectiveness studies would be helpful to inform policy-makers to take appropriate decisions.

[Burden of hospitalization for pneumonia in a Spanish tertiary hospital. Period 2009-2014]. / Carga de hospitalización por neumonía en un hospital terciario español. Período 2009-2014.

BACKGROUND: The aim of this paper is to estimate the burden of hospitalization for community-acquired pneumonia and pneumococcal pneumonia at a tertiary level hospital in the Spanish National Health System. METHODS: A retrospective study which compiles data from the Minimum Data Set using clinical codes of the International Code of Diseases, as well as the hospitalization rate index per thousand inhabitants, the hospitalization rate per thousand population, mortality and fatality rate, using as denominator the demographic data of the population of the Health Area. RESULTS: The discharge of 5758 episodes coded with CIE codes 480 to 486 related to pneumonia, indicates an hospitalization rate of 3.54 people hospitalized per 1000 inhabitants, 65.34 % of all hospital admissions occured in Internal Medicine Services and Pneumology. The average hospital stay per year is 16.63 days. The crude death rate is 69.15 per 100 000 inhabitants and the fatality rate is 19.56 % being higher in adults over 65 years. CONCLUSIONS: Despite the current therapeutic and preventive measures, the incidence and mortality of community-acquired pneumonia in adults remains high, which justifies the strengthening and awareness to address new strategies and prevention such as vaccination.

Introducción: el objetivo de este trabajo es estimar la carga de hospitalización por neumonía adquirida en la comunidad y neumonía neumocócica en un hospital de nivel terciario del Sistema Nacional de Salud Español. Métodos: estudio retrospectivo en el que se recogen los datos del Conjunto Mínimo de Datos Básicos que usa códigos clínicos del Código Internacional de Enfermedades, asi como el índice de hospitalización por mil habitantes, la tasa de hospitalización por mil habitantes, el índice de mortalidad y la tasa de letalidad, usando como denominador los datos demográficos de la población del Área de Salud. Resultados: la descarga de 5758 episodios codificados con los códigos CIE 480 a 486 relativos a neumonía, señalan un índice de hospitalización de 3.54 personas hospitalizadas por cada 1000 habitantes, 65.34% del total de ingresos hospitalarios se produce en los Servicios de Medicina Interna y de Neumología. La estancia media hospitalaria por año es de 16.63 días. La tasa bruta de mortalidad es de 69.15 cada 100 000 y la tasa de letalidad de 19.56%, siendo más elevadas en adultos mayores de 65 años. Conclusiones: a pesar de las medidas terapéuticas y preventivas actuales, la incidencia y la mortalidad por neumonía adquirida en la comunidad en adultos se mantienen elevadas, lo que justifica fortalecer y abordar nuevas estrategias de concienciación y prevención.

[Gastos hospitalarios por neumonía neumocóccica invasora en adultos en un hospital general en Chile]. / Hospital charges by bacteremic pneumococcal pneumonia in adults in a general hospital.

Pneumococcal infections are important for their morbidity and economic burden, but there is no economical data from adults patients in Chile. AIMS: Estimate direct medical costs of bacteremic pneumococcal pneumonia among adult patients hospitalized in a general hospital and to evaluate the sensitivity of ICD 10 discharge codes to capture infections from this pathogen. METHODS: Analysis of hospital charges by components in a group of patients admitted for bacteremic pneumococcal pneumonia, correction of values by inflation and conversion from CLP to US$. RESULTS: Data were collected from 59 patients admitted during 2005-2010, mean age 71.9 years. Average hospital charges for those managed in general wards reached 2,756 US$, 8,978 US$ for those managed in critical care units (CCU) and 6,025 for the whole group. Charges were higher in CCU (p < 0.001), and patients managed in these units generated 78.3% of the whole cost (n = 31; 52.5% from total). The median cost in general wards was 1,558 US$, and 3,993 in CCU. Main components were bed occupancy (37.8% of charges), and medications (27.4%). There were no differences associated to age, comorbidities, severity scores or mortality. No single ICD discharge code involved a S. pneumoniae bacteremic case (0% sensitivity) and only 2 cases were coded as pneumococcal pneumonia (3.4%). CONCLUSIONS: Mean hospital charges (~6,000 US dollars) or median values (~2,400 US dollars) were high, underlying the economic impact of this condition. Costs were higher among patients managed in CCU. Recognition of bacteremic pneumococcal infections by ICD 10 discharge codes has a very low sensitivity.

Gastos hospitalarios por neumonía neumocóccica invasora en adultos en un hospital general en Chile / Hospital charges by bacteremic pneumococcal pneumonia in adults in a general hospital

Pneumococcal infections are important for their morbidity and economic burden, but there is no economical data from adults patients in Chile. Aims. Estimate direct medical costs of bacteremic pneumococcal pneumonia among adult patients hospitalized in a general hospital and to evaluate the sensitivity of ICD 10 discharge codes to capture infections from this pathogen. Methods. Analysis of hospital charges by components in a group of patients admitted for bacteremic pneumococcal pneumonia, correction of values by inflation and conversion from CLP to US$. Results. Data were collected from 59 patients admitted during 2005-2010, mean age 71.9 years. Average hospital charges for those managed in general wards reached 2,756 US$, 8,978 US$ for those managed in critical care units (CCU) and 6,025 for the whole group. Charges were higher in CCU (p < 0.001), and patients managed in these units generated 78.3% of the whole cost (n = 31; 52.5% from total). The median cost in general wards was 1,558 US$, and 3,993 in CCU. Main components were bed occupancy (37.8% of charges), and medications (27.4%). There were no differences associated to age, comorbidities, severity scores or mortality. No single ICD discharge code involved a S. pneumoniae bacteremic case (0% sensitivity) and only 2 cases were coded as pneumococcal pneumonia (3.4%). Conclusions. Mean hospital charges (~6,000 US dollars) or median values (~2,400 US dollars) were high, underlying the economic impact of this condition. Costs were higher among patients managed in CCU. Recognition of bacteremic pneumococcal infections by ICD 10 discharge codes has a very low sensitivity.

Las infecciones neumocócicas representan una gran carga de morbilidad y de gastos en salud en pacientes adultos pero no se dispone de datos que hayan evaluado su dimensión económica en Chile. Objetivo: Evaluar los gastos directos en un grupo de pacientes adultos hospitalizados por neumonía neumocóccica bacterémica en un hospital general y evaluar la sensibilidad de los códigos de egreso CIE 10 para capturar las infecciones por este patógeno. Métodos: Análisis de gastos por componentes de un grupo de pacientes atendidos por neumonía neumocóccica bacteriémica, actualización de gastos y conversión a US$. Resultados: Se rescató información de 59 pacientes atendidos entre el 2005-2010, con edad promedio de 71,9 años. El gasto promedio en sala fue de 2.756 US$, de 8.978 US$ en Unidades Críticas y de 6.025 US$ para el grupo total. Los gastos fueron mayores en Unidades Críticas (p < 0,001) y los pacientes en estas unidades (n = 31; 52,5% del total) generaron el 78,3% del gasto total observado. La mediana de gastos en sala fue de 1.558 US$ y de 3.993 US$ en el caso de Unidades Críticas. El 37,8% del gasto se originó por día-cama y 27,4% por medicamentos. No hubo diferencias por edad, co-morbilidades, scores de gravedad o mortalidad. Ningún código CIE 10 involucró bacteriemia por S. pneumoniae (Sensibilidad 0%) y sólo 2 casos fueron codificados como neumonía neumocóccica (3,4%). Conclusiones: El gasto promedio (aprox. 6.000 dólares americanos) y mediana (aprox. 2.400 dólares americanos) fueron elevados evidenciando la importancia económica de esta enfermedad. Los gastos fueron mayores en pacientes manejados en Unidades Críticas. La sensibilidad de los códigos CIE 10 fue baja para reconocer eventos de ENI en esta serie.

Measurement and valuation of health providers' time for the management of childhood pneumonia in rural Malawi: an empirical study.

BACKGROUND: Human resources are a major cost driver in childhood pneumonia case management. Introduction of 13-valent pneumococcal conjugate vaccine (PCV-13) in Malawi can lead to savings on staff time and salaries due to reductions in pneumonia cases requiring admission. Reliable estimates of human resource costs are vital for use in economic evaluations of PCV-13 introduction. METHODS: Twenty-eight severe and twenty-four very severe pneumonia inpatients under the age of five were tracked from admission to discharge by paediatric ward staff using self-administered timesheets at Mchinji District Hospital between June and August 2012. All activities performed and the time spent on each activity were recorded. A monetary value was assigned to the time by allocating a corresponding percentage of the health workers' salary. All costs are reported in 2012 US$. RESULTS: A total of 1,017 entries, grouped according to 22 different activity labels, were recorded during the observation period. On average, 99 min (standard deviation, SD = 46) were spent on each admission: 93 (SD = 38) for severe and 106 (SD = 55) for very severe cases. Approximately 40 % of activities involved monitoring and stabilization, including administering non-drug therapies such as oxygen. A further 35 % of the time was spent on injecting antibiotics. Nurses provided 60 % of the total time spent on pneumonia admissions, clinicians 25 % and support staff 15 %. Human resource costs were approximately US$ 2 per bed-day and, on average, US$ 29.5 per severe pneumonia admission and US$ 37.7 per very severe admission. CONCLUSIONS: Self-reporting was successfully used in this context to generate reliable estimates of human resource time and costs of childhood pneumonia treatment. Assuming vaccine efficacy of 41 % and 90 % coverage, PCV-13 introduction in Malawi can save over US$ 2 million per year in staff costs alone.

Pneumococcal lower respiratory tract infections in adults: an observational case-control study in primary care in Belgium.

BACKGROUND: Serious lower respiratory tract infections (SLRTIs), especially Streptococcus pneumoniae (SP)-related pneumonia cause considerable morbidity and mortality. Chest imaging, sputum and blood culture are not routinely obtained by general practitioners (GPs). Antibiotic therapy is usually started empirically. The BinaxNOW® and Urine Antigen Detection (UAD) assays have been developed respectively to detect a common antigen from all pneumococcal strains and the 13 pneumococcal serotypes present in the vaccine Prevenar 13® (PCV13). METHODS: OPUS-B was a multicentre, prospective, case-control, observational study of patients with SLRTI in primary care in Belgium, conducted during two winter seasons (2011-2013). A urine sample was collected at baseline for the urine assays. GPs were blinded to the results. All patients with a positive BinaxNOW® test and twice as much randomly selected BinaxNOW® negative patients were followed up. Recorded data included: socio-demographics, medical history, vaccination history, clinical symptoms, CRB-65 score, treatments, hospitalization, blood cultures, healthcare use, EQ-5D score. The objectives were to evaluate the percentage of SP SLRTI within the total number of SLRTIs, to assess the percentage of SP serotypes and to compare the burden of disease between pneumococcal and non-pneumococcal SLRTIs. RESULTS: There were 26 patients with a BinaxNOW® positive test and 518 patients with a BinaxNOW® negative test. The proportion of pneumococcal SLRTI was 4.8 % (95 % CI: 3.1 %-7.2 %). Sixty-eight percent of positive cases showed serotypes represented in PCV13. In the BinaxNOW-positive patients, women were more numerous, there was less exposure to young children, seasonal influenza vaccination was less frequent, COPD was more frequent, the body temperature and the number of breaths per minute were higher, the systolic blood pressure was lower, the frequency of sputum, infiltrate, chest pain, muscle ache, confusion/disorientation, diarrhoea, pneumonia and exacerbations of COPD was more frequent, EQ-5D index and VAS scale were lower, the number of visits to the GP, of working days lost and of days patients needed assistance were higher. CONCLUSIONS: SP was responsible for approximately 5 % of SLRTIs observed in primary care in Belgium. Pneumococcal infection was associated with a significant increase in morbidity. Sixty-eight percent of serotypes causing SLRTI were potentially preventable by PCV13.

[Economic cost of Streptococcus pneumoniae community-acquired pneumonia, meningitis and bacteremia in an adult population that required hospitalization in Bogotá, Colombia]. / Costos económicos de neumonía adquirida en comunidad, meningitis y bacteriemia por Streptococcus pneumoniae en una población adulta que requirió hospitalización en Bogotá, Colombia.

INTRODUCTION: Streptococcus pneumoniae infection in adults is related to pneumonia, meningitis and bacteremia. Its care costs in adults are not well documented in Colombia and it has a greater impact in people over 45 years old. OBJECTIVES: The aims of this study were to analyze the associated costs of pneumonia, bacteremia and meningitis in invasive S. pneumoniae infection in Colombia among hospitalized adults and to estimate outpatient costs for community-acquired pneumonia. Additionally, we wanted to serve as a starting point for future economic evaluations. MATERIALS AND METHODS: We performed a direct cost study associated with S. pneumoniae outpatient community-acquired pneumonia, bacteremia and meningitis costs confirmed by cultures. A cohort of hospitalized adults treated between January 2010 and June 2011 in three third level hospitals in Bogotá was analyzed. We evaluated 107 records and 60 bills charged to the payer. The data were classified according to care and treatment costs. We performed an estimate of direct costs for community-acquired pneumonia for outpatient cases through Delphi methodology using expert clinicians. RESULTS: The average direct costs associated with pneumococcal disease were US$ 6,283, US$ 3,886, and US$ 4,768 for pneumonia, meningitis and bacteremia, respectively (exchange rate 1 US$ = Col$ 1,938.34; average variation between 2010 and 2011). Pneumonia cases were 70% men and 30% women; the distribution for meningitis was the same for both genders (50%); and for bacteremia we had 67% men and 33% women. Outpatient cost of community-acquired pneumonia was estimated at US$ 82.2 ( Col $ 159,280 ) in adults. For special cases, direct cost increased to US$ 142 ( Col $ 274,427). CONCLUSIONS: The management of S. pneumoniae infection in people over 45 years old represents a high cost due to the use of drugs and hospitalization, which has a direct impact on health resources. Prevention and early treatment for pneumonia can reduce the cost and the burden of the disease.

Costos económicos de neumonía adquirida en comunidad, meningitis y bacteriemia por Streptococcus pneumoniae en una población adulta que requirió hospitalización en Bogotá, Colombia / Economic cost of Streptococcus pneumoniae community-acquired pneumonia, meningitis and bacteremia in an adult population that required hospitalization in Bogotá, Colombia

Introducción. Las infecciones por Streptococcus pneumoniae en adultos se relacionan con neumonía, meningitis y bacteriemia. El costo de la atención en personas adultas no está bien documentado en Colombia, pero puede ser significativo. Objetivo. Analizar los costos asociados con la neumonía adquirida en comunidad, meningitis y bacteriemia por S. pneumoniae en adultos hospitalizados en Colombia y estimar el costo de la atención ambulatoria de esta neumonía. Servir de base para futuras evaluaciones económicas. Materiales y métodos. Se realizó un estudio de costos directos asociados a neumonía adquirida en comunidad, meningitis y bacteriemia por S. pneumoniae confirmado por cultivos. Se tomó una muestra de conveniencia de adultos hospitalizados entre enero de 2010 y junio de 2011 en tres hospitales de tercer nivel de Bogotá. Se analizaron 107 registros y se obtuvieron 60 facturas cobradas al pagador. La información se clasificó por costos de atención y tratamiento. Para los casos ambulatorios de neumonía, el estimativo de costos se hizo utilizando metodología Delphi con expertos clínicos. Resultados. El promedio de los costos directos totales asociados con neumonía fue de Col$ 12´178.949, Col$ 7´533.187 para meningitis y Col$ 9´242.806 para bacteriemia. La neumonía se presentó en 70 % de los hombres y 30 % de las mujeres; la meningitis se distribuyó igual en ambos sexos (50 %) y la bacteriemia se presentó en 67 % de los hombres y 33 % de las mujeres. El costo por adulto de la atención ambulatoria de la neumonía adquirida en la comunidad se estimó en Col$ 106.174. Para casos especiales se incrementó a Col$ 164.695. Conclusión. La enfermedad neumocócica en adultos, especialmente mayores de 45 años, representa un alto costo por el empleo de medicamentos y la estancia hospitalaria, que causan un impacto en los recursos del sistema. La prevención y el tratamiento temprano de las neumonías pueden disminuir costos y reducir la carga de enfermedad.

Introduction: Streptococcus pneumoniae infection in adults is related to pneumonia, meningitis and bacteremia. Its care costs in adults are not well documented in Colombia and it has a greater impact in people over 45 years old. Objectives: The aims of this study were to analyze the associated costs of pneumonia, bacteremia and meningitis in invasive S. pneumoniae infection in Colombia among hospitalized adults and to estimate outpatient costs for community-acquired pneumonia. Additionally, we wanted to serve as a starting point for future economic evaluations. Materials and methods: We performed a direct cost study associated with S. pneumoniae outpatient community-acquired pneumonia, bacteremia and meningitis costs confirmed by cultures. A cohort of hospitalized adults treated between January 2010 and June 2011 in three third level hospitals in Bogotá was analyzed. We evaluated 107 records and 60 bills charged to the payer. The data were classified according to care and treatment costs. We performed an estimate of direct costs for community-acquired pneumonia for outpatient cases through Delphi methodology using expert clinicians. Results: The average direct costs associated with pneumococcal disease were US$ 6,283, US$ 3,886, and US$ 4,768 for pneumonia, meningitis and bacteremia, respectively (exchange rate 1 US$ = Col$ 1,938.34; average variation between 2010 and 2011). Pneumonia cases were 70% men and 30% women; the distribution for meningitis was the same for both genders (50%); and for bacteremia we had 67% men and 33% women. O utpatient cost of community-acquired pneumonia was estimated at US$ 82.2 ( Col $ 159,280 ) in adults. For special cases, direct cost increased to US$ 142 ( Col $ 274,427). Conclusions: The management of S. pneumoniae infection in people over 45 years old represents a high cost due to the use of drugs and hospitalization, which has a direct impact on health resources. Prevention and early treatment for pneumonia can reduce the cost and the burden of the disease.

Cost of hospitalizing children with invasive pneumococcal pneumonia.

BACKGROUND: Although invasive pneumococcal pneumonia remains responsible for a significant number of child hospitalizations, specific data on hospital resource utilization and related costs are limited. OBJECTIVES: To assess the cost of hospitalizing children with invasive pneumococcal pneumonia and identify the cost determinants of the disease. PATIENTS AND METHODS: Economic evaluation based on an observational study of all children <18 years of age with culture-proved invasive pneumococcal pneumonia admitted to a referral hospital in Barcelona (Spain) during the period January 2001-December 2011. Analysis included demographic, microbiological, epidemiological and clinical variables. RESULTS: A total of 135 children were included in the study (median age 3.3 years). PCV13 serotypes were detected in 132 (97.8%) cases. Median hospital cost was €4533 (€4078-5435, 95% CI). Median length of stay was 11.0 days (10.6-13.0 days, 95% CI). Variables significantly associated with increased cost in the multivariate analysis were complicated pneumonia (≥2 and 1 complication) versus non-complicated pneumonia (€4919 and €2822 vs. €1399), performance of surgery versus no surgery (€4849 vs. €1435), intensive care versus no intensive care (€6488 vs. €3862) and identification of non-PCV7 serotypes versus PCV7 serotypes (€4656 vs. €1470). CONCLUSION: Invasive pneumococcal pneumonia in children makes substantial demands on hospital health care and financial resources that could be mitigated with universal PCV13 childhood immunization programmes and early management of complications.

Pathogenesis, treatment, and prevention of pneumococcal pneumonia.

Pneumococcus remains the most common cause of community-acquired pneumonia worldwide. Streptococcus pneumoniae is well adapted to people, and is a frequent inhabitant of the upper airways in healthy hosts. This seemingly innocuous state of colonisation is a dynamic and competitive process in which the pathogen attempts to engage the host, proliferate, and invade the lower airways. The host in turn continuously deploys an array of innate and acquired cellular and humoral defences to prevent pneumococci from breaching tissue barriers. Discoveries into essential molecular mechanisms used by pneumococci to evade host-sensing systems that are designed to contain the pathogen provide new insights into potential treatment options. Versatility of the genome of pneumococci and the bacteria's polygenic virulence capabilities show that a multifaceted approach with many vaccine antigens, antibiotic combinations, and immunoadjuvant therapies will be needed to control this microbe.

[Direct medical costs of invasive pneumococcal disease and radiologically-diagnosed pneumonia among Chilean children]. / Costos médicos directos de enfermedades neumocócicas invasoras y neumonías con diagnóstico radiológico en niños chilenos.

OBJECTIVES: To determine the direct medical costs of health care services for cases of invasive pneumococcal disease (IPD) and pneumonia acquired in the community and confirmed by radiology (NAC-Rx) among Chilean children. METHODS: A prospective follow-up study of the health services delivered to 594 children 0-35 months of age with IPD and 1 489 children 1-35 months with NAC-Rx, diagnosed and treated by organizations within public health network of the Región Metropolitana de Chile. The value of the health services was established according to rates supplied by the Fondo Nacional de Salud (FONASA, the National Health Fund) and prices charged by two private clinics. The national IPD and NAC-Rx rates were estimated to calculate the total national economic burden for the population covered by state health insurance. RESULTS: The mean cost of cases requiring hospitalization was US$ 1 056.20 for IPD and US$ 594.80 for NAC-Rx, while that of cases treated by out-patient services was US$ 77.70 and US$ 65.20, respectively. The cost of the same services for in-patient care at the private clinics was US$ 4 484.10 and US$ 2 962.70 at one clinic and US$ 9 967.50 and US$ 6 578.40 at the other. The estimated national annual cost of services for children under 5 years of age, according to FONASA rates, was US$ 789 045 for IPD and US$ 13 823 289 for NAC-Rx. CONCLUSIONS: The high demand for services and financial resources for NAC-Rx in children 0-3 years of age is a tremendously powerful public health reason to support the routine use of pneumococcal vaccination in Chilean children.

Costos médicos directos de enfermedades neumocócicas invasoras y neumonías con diagnóstico radiológico en niños chilenos / Direct medical costs of invasive pneumococcal disease and radiologically-diagnosed pneumonia among Chilean children

OBJETIVOS: Determinar los costos médicos directos relacionados con la atención sanitaria de los casos de enfermedades neumocócicas invasoras (ENI) y neumonías adquiridas en la comunidad confirmadas mediante radiología (NAC-Rx) en niños chilenos. MÉTODO: Estudio de seguimiento prospectivo de las prestaciones de salud entregadas a 594 niños de 0 a 35 meses con ENI y 1489 niños de 1 a 35 meses con NAC-Rx, diagnosticados y tratados en establecimientos de la red pública de salud de la Región Metropolitana de Chile. Las prestaciones se valoraron según las tarifas del Fondo Nacional de Salud (FONASA) y los precios de dos clínicas privadas. Se estimó la incidencia nacional anual de ENI y NAC-Rx para calcular la carga económica total nacional de la población afiliada al seguro de salud estatal. RESULTADOS: Los costos promedio de los casos que requirieron hospitalización fueron US$ 1056,20 para las ENI y US$ 594,80 para las NAC-Rx, mientras que para los casos tratados en forma ambulatoria fueron US$ 77,70 y US$ 65,20, respectivamente. Los precios por los mismos servicios de internación fueron US$ 4484,10 y US$ 2962,70 en una de las clínicas privadas y US$ 9967,50 y US$ 6578,40 en la otra. El costo anual nacional estimado de la atención de los niños menores de 5 años según las tarifas de FONASA fue de US$ 789045 para las ENI y US$ 13823289 para las NAC-Rx. CONCLUSIONES: La alta demanda asistencial y económica por NAC-Rx en niños de 0 a 3 años es una razón de salud pública tremendamente poderosa que apoya el uso sistemático de la vacunación antineumocócica en niños chilenos.

OBJECTIVES: To determine the direct medical costs of health care services for cases of invasive pneumococcal disease (IPD) and pneumonia acquired in the community and confirmed by radiology (NAC-Rx) among Chilean children. METHODS: A prospective follow-up study of the health services delivered to 594 children 0-35 months of age with IPD and 1 489 children 1-35 months with NAC-Rx, diagnosed and treated by organizations within public health network of the Región Metropolitana de Chile. The value of the health services was established according to rates supplied by the Fondo Nacional de Salud (FONASA, the National Health Fund) and prices charged by two private clinics. The national IPD and NAC-Rx rates were estimated to calculate the total national economic burden for the population covered by state health insurance. RESULTS: The mean cost of cases requiring hospitalization was US$ 1056.20 for IPD and US$ 594.80 for NAC-Rx, while that of cases treated by out-patient services was US$ 77.70 and US$ 65.20, respectively. The cost of the same services for in-patient care at the private clinics was US$ 4484.10 and US$ 2962.70 at one clinic and US$ 9967.50 and US$ 6578.40 at the other. The estimated national annual cost of services for children under 5 years of age, according to FONASA rates, was US$ 789045 for IPD and US$ 13823289 for NAC-Rx. CONCLUSION: The high demand for services and financial resources for NAC-Rx in children 0-3 years of age is a tremendously powerful public health reason to support the routine use of pneumococcal vaccination in Chilean children.

[Economic aspects of hospitaly treated pneumococcal pneumonia and the results of Pneumo 23 vaccine use in Serbia].

INTRODUCTION: In Serbia, there is a significant number of persons suffering of pneumococcal pneumonia. Persons aged 65 years or older, immunocompromised patients, patients with co-morbidities, such as chronic obstructive lung disease and congestive heart failure, are at the highest risk for developing pneumococcal pneumonia. Most of the patients are treated empirically, although it is often overlooked that Streptococcus pneumoniae can be resistant to the used antibiotics. The treatment costs of such inpatients and outpatients are very high. In Serbia, immunization of persons at risk to develop the diseases caused by Streptococcus pneumoniae is carried out using pneumococcus polysaccharide vaccine according to clinical indications. The exact number of immunized persons and the total number of registered patients are still unknown, but it is certain of being unjustifiably low. OBJECTIVE: The goal of the study was to investigate, during a one-year period, the number and basic characteristics of persons hospitably treated for pneumonia, the type of cause of the infection, applied antibiotic medications, duration and costs of hospital treatment at the Institute for Lung Diseases and Tuberculosis of the Clinical Centre of Serbia in Belgrade. METHOD: We retrospectively analyzed the medical records of patients with pneumonia treated at the Institute for Lung Diseases and Tuberculosis of the Clinical Centre of Serbia in Belgrade during 2006. RESULTS: During the observed one-year period, 290 patients underwent hospital treatment, of whom the cause of the infection was confirmed in 116 (40%). The average duration of hospitalization was 12 days, with treatment cost of 32,031.74 RSD (402.42 EUR) per patient. The treatment cost per patient including general and intensive care was 18,290.01 RSD (229.78 EUR). The distribution cost of Pneumo 23 vaccine in Serbia, without purchase tax, was 746.90 RSD (9.38 EUR). CONCLUSION: Pneumococcal pneumonia is a significant medical and economic problem for the healthcare system of Serbia. The use of antipneumococcal vaccination can be useful in decreasing the overall treatment costs related to pneumococcal infection.

[Cost-effectiveness of 23-valent antipneumococcical vaccination in Catalonia (Spain)]. / Coste-efectividad de la vacunación antineumocócica 23-valente en Cataluña.

OBJECTIVES: Pneumococcal vaccination is an effective procedure for preventing pneumococcal pneumonia. In this study we evaluate the cost-effectiveness of pneumococcal vaccination strategies (23 serotypes) in the population aged 5 years and older in Catalonia. METHODS: Cost-effectiveness was evaluated in terms of cost per year of life gained (YLG) by comparing the net cost of the vaccination program with its effectiveness. The net cost of the vaccination program was calculated by subtracting 70% of the population from the vaccination costs, representing the reduction in health costs due to pneumococcal pneumonia that can ve achieved with vaccination. Vaccination costs were estimated based on a price of 12.41 euros (1,915 ptas.) for pneumococcal vaccine. The costs and benefits of the vaccination program were updated for 1996 by using a discount rate of 5%. RESULTS: A cost-effectiveness ratio of 9,023.27 euros per YLG was achieved for universal vaccination of the population. Cost-effectiveness was 11,3177.12 euros per YLG in individuals aged 5-24 years, 19,482.51 euros per TLG in those aged 25-44 years, 7,122.80 euros per YLG in those aged 45-64 years and less than 0 in those aged 65 years and older. In this group the reduction in cost of the disease was greater than the vaccination costs with a cost-benefit ratio of 1.58. The results of the cost-efecctiveness analysis were sensitive to vaccine costs and efficacy and the percentage of pneumonias caused by pneumococcus but were less sensitive to the costs of pneumococcal pneumonia, the rate of hospital admission among patients with community-acquired pneumonia and vaccine coverage. CONCLUSION: The results of this study show that pneumococcal vaccination should be a priority in individuals aged 65 years and older and in those aged 45-64 years.

The Victorian Ambulatory Care Sensitive Conditions study: reducing demand on hospital services in Victoria.

Ambulatory Care Sensitive Conditions (ACSCs) are those for which hospitalisation is thought to be avoidable if preventive care and early disease management are applied, usually in the ambulatory setting. The Victorian ACSCs study offers a new set of indicators describing differentials and inequalities in access to the primary healthcare system in Victoria. The study used the Victorian Admitted Episodes Dataset (1999-2000) for analysing hospital admissions for diabetes complications, asthma, vaccine preventable influenza and pneumococcal pneumonia. The analyses were performed at the level of Primary Care Partnerships (PCPs). There were 12,100 admissions for diabetes complications in Victoria. There was a 12-fold variation in admission rates for diabetes complications across PCPs, with 13 PCPs having significantly higher rates than the Victorian average, accounting for just over half of all admissions (6114) and 39 per cent total bed days. Similar variations in admission rates across PCPs were observed for asthma, influenza and pneumococcal pneumonia. This analysis, with its acknowledged limitations, has shown the potential for using these indicators as a planning tool for identifying opportunities for targeted public health and health services interventions in reducing demand on hospital services in Victoria.

Evaluating quality indicators for patients with community-acquired pneumonia.

BACKGROUND: Several organizations have published evidence-based quality indicators for community-acquired pneumonia (CAP). However, there is variability in the types of indicators presented between organizations and the level of supporting evidence for each of the indicators. A systematic review of the literature and relevant Internet Web sites was performed to identify quality indicators for CAP that have been proposed or recommended by organizations, and each of the indicators was then critically appraised, using a well-defined set of criteria. METHODOLOGY: The MEDLINE, EMBASE, Best Evidence, and Cochrane Systematic Review databases and Internet Web sites were searched for articles and guidelines published between January 1980 and May 2001 to identify quality indicators for CAP and relevant evidence. Experts in the area of health services research were contacted to identify additional sources. A well-defined set of criteria was applied to evaluate each of the quality indicators. RESULTS: The systematic review of the literature and Internet Web sites yielded 44 CAP-specific quality indicators. The critical appraisal of these indicators yielded 16 indicators that were supported by a study that identified an association between quality of care and the process of care or outcome measure, were applied to enough patients to be able to detect clinically meaningful differences, were clinically and/or economically relevant, were measurable in a clinical practice setting, and were precise in their specifications. CONCLUSIONS: Many organizations recommend indicators for CAP. Indicators may serve as measures of clinical performance for clinicians and hospitals, may help in benchmarking, and may ultimately facilitate improvements in quality of care and cost reductions. However, CAP indicators often vary in their meaningfulness, scientific soundness, and interpretability of results. A set of five critical appraisal questions may assist in the evaluation of which quality indicators are most valid.

Plethysmography for the assessment of pneumococcal pneumonia and passive immunotherapy in a mouse model.

The increasing prevalence of resistance to antibiotics of Streptococcus pneumoniae, the main causative agent of community-acquired bacterial pneumonia, necessitates the development of both new therapeutic strategies and noninvasive methods in order to evaluate their efficacy. The efficacy of passive immunotherapy with human intravenous immunoglobulin (IVIG) or solvent alone, administered intranasally or intravenously, was evaluated in a mouse model of acute pneumonia. Lung bacterial load was also evaluated, using a classical but invasive method, as was respiratory function (minute ventilation, respiratory frequency and tidal volume) using plethysmography, a simple noninvasive method commonly used in inhalation toxicology, but not previously used to assess respiratory infection. Forty-eight hours after infectious challenge, the lung bacterial load was significantly lower in IVIG-treated mice than in untreated mice. At the same time, minute ventilation was significantly lower than reference values for untreated mice (36+/-3 versus 57+/-8 mL.min(-1), p<0.01, and 31+/-2 versus 50+/-5 mL.min(-1), p<0.01 for intranasal and intravenous administration of solvent, respectively) but not in mice treated with IVIG by either route of administration. Plethysmography therefore appears to be a simple and reliable test for the follow-up of acute respiratory infection.