Clinical and Economic Burden of Pneumococcal Disease in Adults 19–64 Years With Immunocompromising Conditions in the United States

Abstract

Background and aims: Older adults with immunocompromising conditions are at high risk for pneumococcal infection. Limited studies have examined both the clinical and economic burden of pneumococcal disease in this population. We assessed pneumococcal disease rates, resource utilization and costs in US adults 65+ years with immunocompromising conditions indicated for pneumococcal vaccination by ACIP. Methods: A retrospective cohort study using medical and pharmacy claims from Humana health plans was conducted to compare rates and cost of all-cause pneumonia, pneumococcal pneumonia and invasive pneumococcal disease (IPD) in older adults 65 + y with and without immunocompromising conditions. Conditions of interest included chronic renal disease, cancer, asplenia, transplant and HIV. Results: Among 4.3 million older adults included in the analysis, 34% had no immunocompromising condition; 16.1% had chronic renal disease, 15.5% cancer, 0.2% asplenia, 0.1% transplant and 0.06% HIV. Older adults with immunocompromising conditions had 3 times the rate of all-cause and pneumococcal pneumonia, and 5 times the rate of IPD compared to healthy older adults respectively. All-cause and pneumococcal pneumonia rates were highest in transplant and asplenia patients. IPD rates were highest in transplant and HIV patients. Per IPD episode, adults with immunocompromising conditions had more hospital visits and longer length of stay compared to healthy adults - 1.0 vs. 0.8 visits and 8.3 vs 6.6 days respectively, but substantially higher costs ($13,694 vs. $10,510). IPD costs were highest in transplant ($18,442) and HIV patients ($15,715). Conclusion: Older adults with immunosuppressive conditions are at high risk of pneumococcal disease, consume more healthcare resources and incur greater costs.