Indirect Costs Associated With Pneumococcal Disease: A Global Targeted Literature Review
Author(s)
Min Huang, PhD1, Jipan Xie, MD, PhD2, Walter Albert Orenstein, MD3, Hela Romdhani, PhD4, Yan Song, PhD5, Elamin Elbasha, BSc, MA, PhD6, Matthew Kelly, MD, MPH7.
1Sr. Principal Scientist, Merck & Co. Inc, North Wales, PA, USA, 2XL Source, Inc., Los Angeles, CA, USA, 3School of Medicine, Emory University, Atlanta, GA, USA, 4Analysis Group, Montreal, QC, Canada, 5Analysis Group, Boston, MA, USA, 6Merck & Co. Inc, West Point, PA, USA, 7Arkansas Children’s Hospital, Little Rock, AR, USA.
1Sr. Principal Scientist, Merck & Co. Inc, North Wales, PA, USA, 2XL Source, Inc., Los Angeles, CA, USA, 3School of Medicine, Emory University, Atlanta, GA, USA, 4Analysis Group, Montreal, QC, Canada, 5Analysis Group, Boston, MA, USA, 6Merck & Co. Inc, West Point, PA, USA, 7Arkansas Children’s Hospital, Little Rock, AR, USA.
OBJECTIVES: We sought to synthesize existing evidence on indirect costs associated with acute episodes of pneumococcal disease (PD).
METHODS: A targeted literature review was conducted globally using MEDLINE (2010-2024) to identify original studies estimating indirect cost per PD episode. Mean costs were extracted and adjusted to 2024 USD using currency conversion rates and the U.S. Consumer Price Index. Results were summarized by PD category in children (0 ̶ 17 years) and adults (≥18 years).
RESULTS: Eleven studies were identified — eight in children and three in adults. All studies used the human capital approach to estimate productivity loss associated with morbidity. Among children, one study each reported mean cost of caregiver productivity loss per episode of invasive pneumococcal disease (IPD) ($217), inpatient pneumonia ($430), and unspecified pneumonia ($219). All three studies focused solely on absenteeism, and the studies on IPD and inpatient pneumonia considered absenteeism during hospitalization only. Five studies estimated indirect cost for acute otitis media (AOM): one focused on absenteeism only ($105), while the remaining four also included presenteeism, unpaid work, and loss of leisure time [median (range) of mean costs: $698 ($264-1,221)]. Key drivers of cost variability included differences in the components of productivity loss, productivity loss time, and wage across countries, and episode definitions. All three adult studies focused on pneumonia and considered absenteeism only. The median (range) cost per episode was $4,523 ($736-9,503) for inpatient pneumonia (n=3) and $2,270 ($1,908-2,631) for outpatient pneumonia (n=2). Cost variability was mostly driven by differences in wages and episode definitions.
CONCLUSIONS: Productivity loss represents a substantial economic burden among children with AOM and adults with pneumonia. However, existing evidence for IPD and pneumonia in children is limited. The substantial variability across studies highlights heterogeneity in methodologies. Future studies should address these gaps and capture all relevant productivity loss.
METHODS: A targeted literature review was conducted globally using MEDLINE (2010-2024) to identify original studies estimating indirect cost per PD episode. Mean costs were extracted and adjusted to 2024 USD using currency conversion rates and the U.S. Consumer Price Index. Results were summarized by PD category in children (0 ̶ 17 years) and adults (≥18 years).
RESULTS: Eleven studies were identified — eight in children and three in adults. All studies used the human capital approach to estimate productivity loss associated with morbidity. Among children, one study each reported mean cost of caregiver productivity loss per episode of invasive pneumococcal disease (IPD) ($217), inpatient pneumonia ($430), and unspecified pneumonia ($219). All three studies focused solely on absenteeism, and the studies on IPD and inpatient pneumonia considered absenteeism during hospitalization only. Five studies estimated indirect cost for acute otitis media (AOM): one focused on absenteeism only ($105), while the remaining four also included presenteeism, unpaid work, and loss of leisure time [median (range) of mean costs: $698 ($264-1,221)]. Key drivers of cost variability included differences in the components of productivity loss, productivity loss time, and wage across countries, and episode definitions. All three adult studies focused on pneumonia and considered absenteeism only. The median (range) cost per episode was $4,523 ($736-9,503) for inpatient pneumonia (n=3) and $2,270 ($1,908-2,631) for outpatient pneumonia (n=2). Cost variability was mostly driven by differences in wages and episode definitions.
CONCLUSIONS: Productivity loss represents a substantial economic burden among children with AOM and adults with pneumonia. However, existing evidence for IPD and pneumonia in children is limited. The substantial variability across studies highlights heterogeneity in methodologies. Future studies should address these gaps and capture all relevant productivity loss.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE551
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Infectious Disease (non-vaccine)