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NEUROLOGY 2007;68:1938-1943
© 2007 American Academy of Neurology

The cost of pneumonia after acute stroke

I. L. Katzan, MD, MS, N. V. Dawson, MD, C. L. Thomas, MS, M. E. Votruba, PhD and R. D. Cebul, MD

From the Center for Health Care Research & Policy (I.L.K., N.V.D., C.L.T., M.E.V., R.D.C.), MetroHealth Medical Center; Department of Medicine (N.V.D., R.D.C.), Weatherhead School of Management (M.E.V.), Case Western Reserve University; and Department of Neurology, Cleveland Clinic Foundation (I.L.K.), Cleveland, OH.

Address correspondence and reprint requests to Dr. Irene Katzan, Center for Health Care Research & Policy, Rammelkamp Research & Education Building, Rm 237A, 2500 MetroHealth Drive, Cleveland, OH 44109

Objective: To determine the incremental costs of pneumonia occurring during hospitalization for stroke.

Methods: We reviewed hospital records of all Medicare patients admitted for ischemic or hemorrhagic stroke to 29 hospitals in a large metropolitan area, 1991 through 1997, excluding those who died or had do not resuscitate orders written within 3 days of admission. Hospital costs of patients with stroke were determined using Medicare Provider Analysis and Review data after adjustment for baseline factors affecting cost and propensity for pneumonia. Secondary analyses examined the risk-adjusted relationship of pneumonia to discharge disposition.

Results: Pneumonia occurred in 5.6% (635/11,286) of patients with stroke, and was more common among patients admitted from nursing homes and those with greater severity of illness (p < 0.001). Mean adjusted costs of hospitalization for patients with stroke with pneumonia were $21,043 (95% CI $19,698 to 22,387) and were $6,206 (95% CI $6,150 to 6,262) for patients without pneumonia, resulting in an incremental cost of $14,836 (95% CI $14,436 to 15,236). Patients with pneumonia were over 70% more likely to be discharged with requirements for extended care (adjusted OR 1.73, 95% CI 1.32 to 2.26).

Conclusion: Extrapolated to the over 500,000 similar patients hospitalized for stroke in the United States, the annual cost of pneumonia as a complication after acute stroke is approximately $459 million.

ikatzan{at}metrohealth.org

Supported by NINDS K23NS45003 (I.L.K.) and AHRQ RO1-HS09969 (R.D.C.).

Disclosure: Irene Katzan has received speaking honoraria from Genentech, Inc., and Bristol-Myers-Squibb.

Received November 7, 2006. Accepted in final form February 1, 2007.




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