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Societal Cost of Racial Pneumococcal Disease Disparities in US Adults Aged 50 Years or Older

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Abstract

Objective

This study aimed to estimate the societal cost of racial disparities in pneumococcal disease among US adults aged ≥  50 years.

Methods

In a model-based analysis, societal costs of invasive pneumococcal disease (IPD) and hospitalized nonbacteremic pneumococcal pneumonia (NBP) were estimated using (1) direct medical costs plus indirect costs of acute illness; (2) indirect costs of pneumococcal mortality; and (3) direct and indirect costs of related disability. Disparities costs were calculated as differences in average per-person pneumococcal disease cost between Black and non-Black adults aged ≥  50 years multiplied by the Black population aged ≥  50 years. Costs were in 2019 US dollars (US$), with future costs discounted at 3% per year.

Results

Total direct and indirect costs per IPD case were US$186,791 in Black populations and US$182,689 in non-Black populations; total hospitalized NBP costs per case were US$100,632 (Black) and US$96,781 (non-Black). The difference in population per-person total pneumococcal disease costs between Black and non-Black adults was US$47.85. Combined societal costs of disparities for IPD and hospitalized NBP totaled US$673.2 million for Black adults aged ≥  50 years. Disease and disability risks, life expectancy, and case-fatality rates were influential in one-way sensitivity analyses, but the lowest cost across all analyses was US$194 million. The 95% probability range of racial disparity costs were US$227.2–US$1156.9 million in a probabilistic sensitivity analysis.

Conclusions

US societal cost of racial pneumococcal disease disparities in persons aged ≥ 50 years is substantial. Successful pneumococcal vaccination policy and programmatic interventions to mitigate these disparities could decrease costs and improve health.

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References

  1. Shoar S, Musher DM. Etiology of community-acquired pneumonia in adults: a systematic review. Pneumonia (Nathan). 2020;12:11.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ludwig E, Bonanni P, Rohde G, Sayiner A, Torres A. The remaining challenges of pneumococcal disease in adults. Eur Respir Rev. 2012;21(123):57–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. McLaughlin JM, McGinnis JJ, Tan L, Mercatante A, Fortuna J. Estimated human and economic burden of four major adult vaccine-preventable diseases in the United States, 2013. J Prim Prev. 2015;36(4):259–73.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Feldman C, Anderson R. Recent advances in our understanding of Streptococcus pneumoniae infection. F1000Prime Rep. 2014;6:82.

    Article  PubMed  PubMed Central  Google Scholar 

  5. National Center for Immunization and Respiratory Diseases DoBD, Centers for Disease Control and Prevention (CDC). About pneumococcal disease. https://www.cdc.gov/PNEUMOCOCCAL/ABOUT/. [Accessed September 2022].

  6. File TM Jr, Marrie TJ. Burden of community-acquired pneumonia in North American adults. Postgrad Med. 2010;122(2):130–41.

    Article  PubMed  Google Scholar 

  7. Huang SS, Johnson KM, Ray GT, Wroe P, Lieu TA, Moore MR, et al. Healthcare utilization and cost of pneumococcal disease in the United States. Vaccine. 2011;29(18):3398–412.

    Article  PubMed  Google Scholar 

  8. Weycker D, Sato R, Strutton D, Edelsberg J, Atwood M, Jackson LA. Public health and economic impact of 13-valent pneumococcal conjugate vaccine in US adults aged >/=50 years. Vaccine. 2012;30(36):5437–44.

    Article  PubMed  Google Scholar 

  9. Centers for Disease Control and Prevention. 2018. Active Bacterial Core Surveillance Report, Emerging Infections Program Network, Streptococcus pneumoniae, 2018. https://www.cdc.gov/abcs/reports-findings/survreports/spneu18.pdf. [Accessed October 2022].

  10. Owusu-Edusei K, Deb A, Johnson KD. Estimates of the health and economic burden of pneumococcal infections attributable to the 15-valent pneumococcal conjugate vaccine serotypes in the USA. Infect Dis Ther. 2022;11(3):987–99.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Brown JD, Harnett J, Chambers R, Sato R. The relative burden of community-acquired pneumonia hospitalizations in older adults: a retrospective observational study in the United States. BMC Geriatr. 2018;18(1):92.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Burton DC, Flannery B, Bennett NM, Farley MM, Gershman K, Harrison LH, et al. Socioeconomic and racial/ethnic disparities in the incidence of bacteremic pneumonia among US adults. Am J Public Health. 2010;100(10):1904–11.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Nowalk MP, Wateska AR, Lin CJ, Schaffner W, Harrison LH, Zimmerman RK, et al. Racial disparities in adult pneumococcal vaccination indications and pneumococcal hospitalizations in the US. J Natl Med Assoc. 2019;111(5):540–5.

    PubMed  Google Scholar 

  14. Kolobova I, Nyaku MK, Karakusevic A, Bridge D, Fotheringham I, O’Brien M. Burden of vaccine-preventable diseases among at-risk adult populations in the US. Hum Vaccin Immunother. 2022;18(5):2054602.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Park H, Adeyemi AO, Rascati KL. Direct medical costs and utilization of health care services to treat pneumonia in the United States: an analysis of the 2007–2011 medical expenditure panel survey. Clin Ther. 2015;37(7):1466–76.

    Article  PubMed  Google Scholar 

  16. Smith KJ, Wateska AR, Nowalk MP, Lin CJ, Harrison LH, Schaffner W, et al. Higher-valency pneumococcal conjugate vaccines: an exploratory cost-effectiveness analysis in U.S. seniors. Am J Prev Med. 2021;61(1):28–36.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Sevilla JP, Stawasz A, Burnes D, Agarwal A, Hacibedel B, Helvacioglu K, et al. Indirect costs of adult pneumococcal disease and the productivity-based rate of return to the 13-valent pneumococcal conjugate vaccine for adults in Turkey. Hum Vaccin Immunother. 2020;16(8):1923–36.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Torres A, Cilloniz C, Blasi F, Chalmers JD, Gaillat J, Dartois N, et al. Burden of pneumococcal community-acquired pneumonia in adults across Europe: a literature review. Respir Med. 2018;137:6–13.

    Article  PubMed  Google Scholar 

  19. Imai K, Petigara T, Kohn MA, Nakashima K, Aoshima M, Shito A, et al. Risk of pneumococcal diseases in adults with underlying medical conditions: a retrospective, cohort study using two Japanese healthcare databases. BMJ Open. 2018;8(3): e018553.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kobayashi M, Farrar JL, Gierke R, Britton A, Childs L, Leidner AJ, et al. Use of 15-valent pneumococcal conjugate vaccine and 20-valent pneumococcal conjugate vaccine among U.S. Adults: updated recommendations of the advisory committee on immunization practices-United States, 2022. MMWR Morb Mortal Wkly Rep. 2022;71(4):109–17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Thorpe RJ Jr, Fesahazion RG, Parker L, Wilder T, Rooks RN, Bowie JV, et al. Accelerated health declines among African Americans in the USA. J Urban Health. 2016;93(5):808–19.

    Article  PubMed  PubMed Central  Google Scholar 

  22. See I, Wesson P, Gualandi N, Dumyati G, Harrison LH, Lesher L, et al. Socioeconomic factors explain racial disparities in invasive community-associated methicillin-resistant Staphylococcus aureus disease rates. Clin Infect Dis. 2017;64(5):597–604.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Said MA, Johnson HL, Nonyane BA, Deloria-Knoll M, O’Brien KL, Team AAPBS, et al. Estimating the burden of pneumococcal pneumonia among adults: a systematic review and meta-analysis of diagnostic techniques. PLoS ONE. 2013;8(4): e60273.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Stoecker C, Kim L, Gierke R, Pilishvili T. Incremental cost-effectiveness of 13-valent pneumococcal conjugate vaccine for adults age 50 years and older in the United States. J Gen Intern Med. 2016;31(8):901–8.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Johannesson M. The willingness to pay for health changes, the human-capital approach and the external costs. Health Policy. 1996;36(3):231–44.

    Article  CAS  PubMed  Google Scholar 

  26. Mangen MJ, Huijts SM, Bonten MJ, de Wit GA. The impact of community-acquired pneumonia on the health-related quality-of-life in elderly. BMC Infect Dis. 2017;17(1):208.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Sisk JE, Whang W, Butler JC, Sneller VP, Whitney CG. Cost-effectiveness of vaccination against invasive pneumococcal disease among people 50 through 64 years of age: role of comorbid conditions and race. Ann Intern Med. 2003;138(12):960–8.

    Article  PubMed  Google Scholar 

  28. Bureau USC. Income and Poverty in the United States: 2019. Retrieved from https://www.census.gov/library/publications/2020/demo/p60-270.html#:~:text=Median%20household%20income%20was%20%2468%2C703,and%20Table%20A%2D1). [Accessed October 2022].

  29. Arias E XJ. United States life tables, 2019. National Vital Statistics Reports. Hyattsville, MD: National Center for Health Statistics. 2022;70(19).

  30. Smith KJ, Wateska AR, Nowalk MP, Raymund M, Nuorti JP, Zimmerman RK. Cost-effectiveness of adult vaccination strategies using pneumococcal conjugate vaccine compared with pneumococcal polysaccharide vaccine. JAMA. 2012;307(8):804–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Khavjou OA, Anderson WL, Honeycutt AA, Bates LG, Hollis ND, Grosse SD, et al. State-level health care expenditures associated with disability. Public Health Rep. 2021;136(4):441–50.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Jia H, Lubetkin EI. Life expectancy and active life expectancy by disability status in older U.S. adults. PLoS ONE. 2020;15(9):e0238890.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Wateska AR, Nowalk MP, Lin CJ, Harrison LH, Schaffner W, Zimmerman RK, et al. Cost-effectiveness of adult pneumococcal vaccination policies in underserved minorities aged 50–64 years compared to the US general population. Vaccine. 2019;37(14):2026–33.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Wateska AR, Nowalk MP, Lin CJ, Harrison LH, Schaffner W, Zimmerman RK, et al. Cost-effectiveness of pneumococcal vaccination and uptake improvement programs in underserved and general population adults aged < 65 years. J Community Health. 2020;45(1):111–20.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Wortham JM, Zell ER, Pondo T, Harrison LH, Schaffner W, Lynfield R, et al. Racial disparities in invasive Streptococcus pneumoniae infections, 1998–2009. Clin Infect Dis. 2014;58(9):1250–7.

    Article  PubMed  Google Scholar 

  36. Jatlaoui. TC, Hung. M-C, Srivastav. A, Lu. P-J, Black. CL, Lindley. MC, et al. Vaccination Coverage among Adults in the United States, National Health Interview Survey, 2019–2020. National Health Interview Survey. https://www.cdc.gov/vaccines/imz-managers/coverage/adultvaxview/pubs-resources/vaccination-coverage-adults-2019-2020.html. [Accessed October 2022].

  37. Gatwood J, Chiu CY, Shuvo S, Ramachandran S, Jadhav S, Hohmeier KC, et al. Role of social determinants of health in pneumococcal vaccination among high-risk adults. Vaccine. 2021;39(14):1951–62.

    Article  PubMed  Google Scholar 

  38. Pike J, Grosse SD. Friction cost estimates of productivity costs in cost-of-illness studies in comparison with human capital estimates: a review. Appl Health Econ Health Policy. 2018;16(6):765–78.

    Article  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Shoroq M. Altawalbeh, Angela R. Wateska, Mary Patricia Nowalk, Richard K. Zimmerman & Kenneth J. Smith

  2. Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan

    Shoroq M. Altawalbeh

  3. The Ohio State University College of Nursing, Columbus, OH, USA

    Chyongchiou J. Lin

  4. Center for Genomic Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Lee H. Harrison

  5. Vanderbilt University School of Medicine, Nashville, TN, USA

    William Schaffner

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  1. Shoroq M. Altawalbeh
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  2. Angela R. Wateska
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Correspondence to Shoroq M. Altawalbeh.

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Author Contributions

Concept and design: Altawalbeh, Lin, Schaffner, Zimmerman, Smith. Acquisition of data: Altawalbeh, Lin, Wateska, Zimmerman, Smith. Analysis and interpretation of data: Altawalbeh, Wateska , Nowalk, Harrison, Schaffner , Smith. Drafting of the manuscript: Altawalbeh, Wateska, Nowalk, Lin, Harrison, Schaffner. Critical revision of the paper for important intellectual content: Altawalbeh, Nowalk, Lin, Harrison, Schaffner, Zimmerman, Smith. Statistical analysis: Altawalbeh. Obtaining funding: Smith. Administrative, technical, or logistic support: Smith. Supervision: Altawalbeh, Smith. All authors read and approved the final manuscript.

Conflict of Interest Disclosures

Dr Wateska has had a research grant from NIAID in the past 3 years. Dr Nowalk has had research grants from Merck & Co., Inc. and Sanofi Pasteur in the past 3 years. Dr Schaffner has had a research grant from CDC in the past 3 years. Dr Zimmerman has had research grants from NIH and Sanofi Pasteur in the last 3 years. Dr Smith has had research grants from NIAID and Sanofi Pasteur in the past 3 years. Other authors have no competing interests to disclose.

Funding/Support:

This study was funded by the National Institute of Allergy and Infectious Diseases (NIAID) R01 AI 116575.

Role of the Funder/Sponsor

 The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data Availability Statement

All data generated or analyzed during this study are included in this paper and its supplementary file.

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Not applicable.

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Not applicable.

Consent for Publication (from patients/participants)

Not applicable.

Code Availability:

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Supplementary Information

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Supplementary file1 (DOCX 23 KB)

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Altawalbeh, S.M., Wateska, A.R., Nowalk, M.P. et al. Societal Cost of Racial Pneumococcal Disease Disparities in US Adults Aged 50 Years or Older. Appl Health Econ Health Policy 22, 61–71 (2024). https://doi.org/10.1007/s40258-023-00854-0

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