The clinical and economic burden of pneumonia in patients enrolled in Medicare receiving dialysis: a retrospective, observational cohort study

BMC Nephrology

Research Article

Wendy Turenne¹  Scott Sibbel¹  Abigail Hunt¹  Steven M. Brunelli¹  Reiko Sato² 

[1] DaVita Clinical Research, 825 South 8th Street, Minneapolis, MN, USA;Pfizer Inc, Collegeville, PA, USA;

关键词: Pneumonia;    Infection;    Hospitalization;    Dialysis;    End-stage renal disease;    Costs;   

DOI  :  10.1186/s12882-016-0412-6

 received in 2016-02-27, accepted in 2016-11-23,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundEnd-stage renal disease (ESRD) patients receiving dialysis are at particular risk for infection. We assessed the clinical and economic burden of pneumonia in a population of Medicare-enrolled ESRD patients with respect to incidence and case fatality rates, rates of all-cause and cardiovascular hospitalization, and costs.MethodsPatients received dialysis between 01 January 2009 and 31 December 2011 and were enrolled in Medicare Parts A and B. Pneumonia episodes were identified from institutional and supplier claims. Patients were considered at-risk from first date of Medicare coverage and were censored upon transplant, withdrawal from dialysis, recovery of renal function, loss of Medicare benefits, or death. Linear mixed-effects models were used to assess hospitalization rates and costs over the 3 months prior to and 12 months following pneumonia episodes.ResultsThe pneumonia incidence rate for the study period was 21.4 events/100 patient-years; the majority of episodes (90.1%) required inpatient treatment. The 30-day case fatality rate was 10.7%. Compared to month -3 prior to event, rates of all-cause and cardiovascular hospitalization were higher in the month of the pneumonia episode (IRR, 4.61 and 4.30). All-cause admission rates remained elevated through month 12; cardiovascular admission rates remained elevated through month 6. Mean per-patient per-month costs were $10,976 higher in the month of index episode compared to month -3, largely driven by increased inpatient costs, and remained elevated through end of 12-month follow-up.ConclusionPneumonia episodes are frequent among ESRD patients and result in hospitalizations and greater overall costs to Medicare over the following year.

【 授权许可】

CC BY   
© The Author(s). 2016