OBJECTIVES: Hospitalization due to whooping cough most frequently occurs in infants and older adults, but there is limited evidence of the health economic implications of this in Germany. This study aims to estimate hospitalization costs and utilization of inpatient care due to B. pertussis (Bordetella pertussis) in Germany.

METHODS: Nationwide cross-sectional data from the Institute for the Hospital Remuneration System (InEK) were retrospectively analysed for the years 2019 to 2023. B. pertussis cases were identified with ICD-10-GM primary diagnoses A37.0 and A37.9. Mean hospitalization costs, mean length of stay (LOS), and intensive-care unit (ICU) admission were estimated for children (0-17 years) and adults (≥18 years) for each year.

RESULTS: Across study years, 714 children (2019-2023: 389, 139, 21, 34, 131) and 523 adults (2019-2023: 251, 105, 62, 49, 56) were hospitalized with B. pertussis. Among adults, 78.0% were aged ≥50 years. From 2019 to 2023, the yearly hospitalization costs per case ranged from €2,524 to €3,078 in children and €3,022 to €3,917 in adults. Costs among adults increased with age, ranging from €2,466 to €3,499 in those aged 18-49 years, €3,022 to €3,852 in those aged 50-59 years, €3,022 to €3,854 in those aged 60-79 years and €3,022 to €4,953 in those aged ≥80 years. Costs were higher with presence of pneumonia (children: €2,745-€3,584, adults: €3,010-€5,099) or acute respiratory distress syndrome (children: €3,022-€5,417, adults: €3,022-€5,446). Among children and adults, LOS (standard deviation) ranged from 3.4 (1.5) to 6.0 (6.7) days and 6.6 (3.9) to 7.8 (6.3) days, respectively. Across study years, 7.0% of children and 3.3% of adults required ICU admission.

CONCLUSIONS: Our findings highlight that both infants and adults are at risk of B. pertussis hospitalizations, which is associated with considerable hospitalization costs. Costs in adults increase with age. Hence, booster vaccinations are of considerable economic relevance.