Resource utilisation and cost of hospitalisation with community-acquired pneumonia among older adults in India, 2018-2020.

INTRODUCTION

Community-acquired pneumonia (CAP) is an important cause of hospitalisation among older adults. Assessing costs of CAP hospitalisation aids in economic evaluation of preventive interventions and guides policy decisions.

METHODS

We estimated resource utilisation rates and costs from a societal perspective among adults aged >60 years admitted with CAP in eight public and eight private hospitals in four Indian cities (ie, National Capital Region-Delhi, Kolkata, Pune and Chennai) from December 2018 to March 2020. We interviewed patients, reviewed medical records and bills to estimate resources used, direct medical cost of diagnosis and treatment; direct non-medical cost of travel, lodging and food; and indirect cost of patients and caregivers' lost income from admission to discharge. Mean costs with SD by hospital type, age group, chronic condition, critical care (intensive care unit, ICU) and virus detection are presented in US dollars (US$). Linear regression after log transformation was conducted to identify determinants of total cost.

RESULTS

We analysed data from 1009 CAP patients in private (63%) and public (37%) hospitals with a median age of 68 (IQR: 63-75) years. Influenza was detected in 121 (12%) and respiratory syncytial virus (RSV) in 21 (2%). Mean length of stay was 6.2 (SD 4.8) days; 37% required ICU admission. Antibiotics and antivirals were used in 96% and 23% of admissions, respectively. Mean (SD) CAP hospitalisation cost was US$305 (244) in public and US$1210 (1019) in private hospitals; US$1024 (1095) in influenza and US$943 (778) in RSV-associated CAP. Regression analysis showed that cost was higher in hospitalisation in private hospitals, those requiring ICU care and among persons with comorbid conditions.

CONCLUSIONS

Substantial resources were used, and costs were incurred during CAP hospitalisation among older adults. The findings could aid in cost-benefit analyses of interventions to reduce pneumonia burden, including influenza, RSV or pneumococcal vaccination in older adults.