OBJECTIVES:

Pneumococcal disease (PD) is a major cause of morbidity, mortality, and economic burden worldwide. This study investigated the clinical and economic burden of PD in adults aged ≥65 years in Sweden.

METHODS: A retrospective population-based study was conducted using Swedish national registers, including patients aged 65-74 and ≥75 years with a diagnosis of pneumococcal pneumonia, meningitis and septicaemia in inpatient or outpatient specialist (hospital) care between 2015-2019. Incident PD infections were defined as diagnoses occurring >30 days apart. PD incidence, 30-day all-cause case fatality rate (CFR), healthcare resource utilisation and costs were estimated, and stratified on clinical presentation.

RESULTS:

During the study period, 6,717 incident infections were identified among 6,334 adults (65-74y: 42.1%, ≥75y: 57.9%). Medical risk factors (RF) associated with higher risk for severe disease were present in 57% (65-74y: 55%, ≥75y: 58%) of patients. PD incidence was estimated at 52.10 (64-74y) and 85.32 (≥75y) per 100,000 population, corresponding to 2,888 (64-74y) and 3,829 (≥75y) incident infections, of which 92.6% and 96.9% respectively required hospitalisation. The 30-day average number of hospitalisations was 1.24 (64-74y) and 1.31 (≥75y), with mean length of stay (LOS) of 7.77 (65-74y) and 8.78 (≥75y) days. Longest LOS was observed among meningitis patients (65-74y: 12.10, ≥75y: 12.89). The average 30-day cost/infection was estimated to €5,300 (65-74y) and €5,900 (≥75y). The 30-day total direct cost of PD between 2015-2019 was €15.2/€22.6 million (65-74y/≥75y) (pneumonia: 76.6%/81.6%, meningitis: 8.7%/3.4%, septicaemia: 14.7%/14.9%). The 30-day CFR (65-74y: 5.4%, ≥75y: 11.7%) increased with age, and was highest among septicemia patients ≥75y (21.4%).

CONCLUSIONS:

Both clinical and economic burden of PD was found to be high and generally comparable between age groups, but PD incidence and CFR was higher among the ≥75 year old. Infections were common among individuals with no recorded RF’s and costs were largely driven by hospitalisation.