Health care and social care costs of pneumonia in Denmark: a register-based study of all citizens and patients with COPD in three municipalities

Susanne Lausten Brogaard,¹ Maj Britt Dahl Nielsen,¹ Lars Ulrik Nielsen,² Trine Mosegaard Albretsen,³ Morten Bundgaard,⁴ Niels Anker,¹ Maja Appel,¹ Kim Gustavsen,¹ Rose-Marie Lindkvist,⁵ Anne Skjoldan,² Grete Breinhild,³ Peter Bo Poulsen<sup>5

1</sup>COWI AS, Management - Health, Kongens Lyngby, ²Seniors and Health Department, Gladsaxe Municipality, Welfare Technology, Søborg, ³Elderly and Health Care Department, Lolland Municipality, Maribo, ⁴Department of Public Health, Holbaek Municipality, Holbaek, ⁵Pfizer Denmark ApS, Health & Value, Ballerup, Denmark

Background: Pneumonia is a frequent lung infection and a serious illness, which is often diagnosed among patients hospitalized with acute exacerbations of COPD. The aim of this study was to estimate the attributable costs due to pneumonia among patients hospitalized with pneumonia compared to a matched general population control group without pneumonia hospitalization.
Methods: This study includes citizens older than 18 years from three municipalities (n=142,344). Based on national registers and municipal data, the health and social care costs of pneumonia in the second half of 2013 are estimated and compared with propensity score-matched population controls.
Results: The average health care costs of 383 patients hospitalized with pneumonia in the second half of 2013 were US$34,561 per patient. Among pneumonia patients with COPD, the costs were US$35,022. The attributable costs of patients with pneumonia compared to the population control group for the 6-month period were US$24,155 per case. Overall, the attributable costs for the 383 pneumonia cases amounted to US$9.25 million. Subgroup analyses showed that costs increased with age. The attributable costs due to pneumonia were highest among the 18–59-year-old and the 70–79-year-old patients. This difference is likely to reflect an increased risk of mortality among the pneumonia patients. Men have higher costs than women in the pneumonia group.
Conclusion: The costs of pneumonia are considerable. In three Danish municipalities, the attributable costs due to pneumonia were US$24,155 per case or US$64,992 per 1,000 inhabitants in the second half of 2013. Similar high health care and social care costs were found for pneumonia patients with COPD – the largest group having pneumonia episodes. The municipalities are responsible for 49% of the costs, while a closer focus on the prevention of pneumonia may be advisable, eg, starting with citizens having COPD.

Keywords: pneumonia, attributable costs, COPD, health care, social care, municipalities