Mortalidade e custos da pneumonia pneumocócica em adultos: um estudo transversal / Mortality and costs of pneumococcal pneumonia in adults: a cross-sectional study

RESUMO Objetivo A pneumonia pneumocócica é uma causa significativa de morbimortalidade entre adultos. Desta maneira, o objetivo principal deste estudo foi avaliar a mortalidade intra-hospitalar e os custos relacionados à doença adquirida em adultos. Métodos Este estudo transversal utilizou prontuários de pacientes adultos com pneumonia pneumocócica internados em um hospital universitário no Brasil, de outubro de 2009 a abril de 2017. Todos os pacientes com idade ≥ 18 anos e diagnosticados com pneumonia pneumocócica foram incluídos. Dados como os fatores de risco, a internação em unidade de terapia intensiva, o tempo de internação, a mortalidade hospitalar e os custos diretos e indiretos foram analisados. Resultados No total, 186 pacientes foram selecionados. A taxa média de mortalidade intra-hospitalar foi de 18% para adultos com idade < 65 anos e 23% para os idosos (≥ 65 anos). A pneumonia pneumocócica bacterêmica acometeu 20% dos pacientes em ambos os grupos, principalmente por doença respiratória crônica (OR ajustada: 3,07; IC95%: 1,23‐7,65; p < 0,01). Após levantamento das internações ocorridas no período de sete anos de tratamento, verificou-se que os custos diretos e indiretos totais anuais foram de US$ 28.188 para adultos < 65 anos (US$ 1.746 per capita) e US$ 16.350 para os idosos (US$ 2.119 per capita). Conclusão A pneumonia pneumocócica continua sendo uma importante causa de morbimortalidade entre adultos, afetando significativamente os custos diretos e indiretos. Esses resultados sugerem a necessidade de estratégias de prevenção para todos os adultos, especialmente para pacientes com doenças respiratórias crônicas.

ABSTRACT Objective Pneumococcal pneumonia is a significant cause of morbidity and mortality among adults. The study's main aim was to evaluate the in-hospital mortality and related costs of community-acquired pneumococcal pneumonia in adults. Methods This cross-sectional study used medical records of adult patients with pneumococcal pneumonia hospitalized in a university hospital in Brazil from October 2009 to April 2017. All patients aged ≥ 18 years diagnosed with pneumococcal pneumonia were included. Risk factors, intensive care unit admission, length of hospital stay, in-hospital mortality, and direct and indirect costs were analyzed. Results In total, 186 patients were selected. The mean in-hospital mortality rate was 18% for adults aged < 65 years and 23% for the elderly (≥ 65 years). Bacteremic pneumococcal pneumonia affected 20% of patients in both groups, mainly through chronic respiratory disease (adjusted OR: 3.07, 95% CI: 1.23-7.65, p < 0.01). Over 7 years, annual total direct and indirect costs were USD 28,188 for adults < 65 years (USD 1,746 per capita) and USD 16,350 for the elderly (USD 2,119 per capita). Conclusion Pneumococcal pneumonia remains an important cause of morbidity and mortality among adults, significantly affecting direct and indirect costs. These results suggest the need for prevention strategies for all adults, especially for patients with chronic respiratory diseases.

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.

Economic Burden and Epidemiology of Pneumonia in Korean Adults Aged over 50 Years

This study was performed to estimate the direct medical costs and epidemiology of pneumonia in adults of Korea. We conducted a multi-center, retrospective, observational study and collected data targeting for community-acquired pneumonia patients ( > or = 50 yr) from 11 hospitals. Costs attributable to the treatment of pneumonia were estimated by reviewing resource utilization and epidemiology data (distribution of pathogen, hospital length of stay, overall outcome) were also collected. A total 693 patients were included; average 70.1 ( +/- 10.5) aged, 57.3% male and average 1.16 CURB-65 (confusion, blood urea nitrogen, respiratory rate, blood pressure, age > 65 yr) scored. The pathogen was identified in the 32.9% (228 patients); Streptococcus pneumoniae accounted for 22.4% (51 patients) of identified pathogens. The hospital mortality was 3.2% (especially, for S. pneumoniae was 5.9%) and average length of stay was 9 days. The mean total cost for the treatment of pneumonia was US dollar (USD) 1,782 (SD: USD 1,501). Compared to the cost of all caused pneumonia, that of pneumococcal pneumonia was higher, USD 2,049 ( +/- USD 1,919), but not statistically significant. Charge of hospitalization accounted the greatest part of total medical costs. The economic burden of pneumonia was high in Korea, and the prevention of pneumonia should be considered as effective strategy.

Piodermias en el medio trópico-rural: factores de riesgo y costos de atención / Pyodermas in tropical rural environment: risk factors and costs of attention

Se ralizó un estudio transversal para determinar la prevalencia de las enfermedades piógenicas de la piel en el medio rural, su asociación a factores de riesgo y costo por atención. Se encuestaron un total de 211 casas con una población de 1,387 personas; se encontró una prevalencia del 6 por ciento de piodermias; sobre los factores de riesgo estudiados, se encontró que una persona que convive con otros pacientes con esta dermatosis tiene más de seis vece el riesgo de tener la enfermedad comparada con otra que no refirió este antecente (RR 6.6, RD 0.12 Xmh 5.6); se utilizó un modelo de regresión logística donde se incluyeron varios factores de manera simultánea