Open Access Research article

Clinical and economic burden of invasive pneumococcal disease in adults: a multicenter hospital-based study

Joon Young Song12, Jun Yong Choi3, Jin Soo Lee4, In-Gyu Bae5, Young Keun Kim6, Jang Wook Sohn7, Yu Mi Jo8, Won Suk Choi9, Jacob Lee10, Kyung Hwa Park11, Woo Joo Kim12 and Hee Jin Cheong12*

Author Affiliations

1 Division of Infectious Disease, Department of Internal Medicine, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 152-703, Republic of Korea

2 Asian Pacific Influenza Institute (APII), Seoul, Republic of Korea

3 Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Yonsei, Seoul, Republic of Korea

4 Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea

5 Division of Infectious Diseases, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang, Republic of Korea

6 Division of Infectious Diseases, Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea

7 Division of Infectious Disease, Department of Internal Medicine, Korea University Anam Hospital, 73 Inchon-ro, Seongbuk-gu, Seoul 136-705, Republic of Korea

8 Division of Infectious Diseases, Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Republic of Korea

9 Division of Infectious Disease, Department of Internal Medicine, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do 425-707, Republic of Korea

10 Division of Infectious Diseases, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea

11 Division of Infectious Diseases, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea

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BMC Infectious Diseases 2013, 13:202  doi:10.1186/1471-2334-13-202

Published: 4 May 2013

Abstract

Background

Streptococcus pneumoniae causes a broad spectrum of illnesses ranging from mild upper respiratory tract infections to invasive pneumococcal disease (IPD). Quantitative data on the burden of pneumococcal disease, important for the establishment of appropriate vaccination strategies, is currently lacking in adults.

Methods

This multicenter, retrospective cohort study was designed to estimate the clinical and economic burden of IPD in adults over the last decade. Data were collected from patients with IPD at 10 university hospitals in South Korea. We estimated the proportion of IPD among all hospitalized patients, the case fatality rate, and the direct medical costs of IPD. Data were further analyzed according to age and risk groups.

Results

During the study period, 970 patients with IPD were identified. The mean age for all patients was 60.9 years; patients aged 50–64 years (33.0%) were most numerous, followed by those aged 65–74 years (27.4%). Overall, the proportion of IPD was 0.36 cases/1000 hospitalized patients and the case fatality rate was 30.9%, which increased significantly with age (p < 0.01). The mean direct medical costs were estimated to be US $7,452 without a difference between age and risk groups. On multivariate analysis, old age, advanced ECOG performance status, bacteremic pneumonia, and nosocomial infection were independent risk factors of 30-day case fatality.

Conclusions

The clinical disease burden of IPD increased significantly with age and direct medical costs from IPD were substantial, regardless of age and co-morbid conditions. The current age-based vaccination strategy appears to be appropriate.

Keywords:
Cost of illness; Pneumococcal infection; Pneumococcal vaccines; Streptococcus pneumoniae