OBJECTIVES: Community-acquired pneumonia (CAP) represents a considerable burden in Russia. We assessed cost of CAP in Russia to characterize disease burden in Russian adults of age 50 and older.   METHODS: We conducted a retrospective chart review in a central Russian region of Tver for samples of 900 patients treated in inpatient and outpatient settings, and extrapolated data nationally.  All patients were 50 years of age and represented new cases of CAP.  Data were collected on demographics, comorbidities, and employment. The cost was estimated from the public payer perspective, with a productivity loss in patients below retirement age. RESULTS: Cost of treatment was similar across age-and-risk groups in hospital and in outpatient settings. The cost of an outpatient episode was estimated far all risk groups at RR2176($69), ranging from RR1,939 ($61) to RR2537 (~$80) for age groups 50-64 and 75-84 respectively; the cost of episode for low-risk patients was RR1737($55), and for moderate-risk RR2378 ($75) for all ages. Average reimbursement rate was RR2,000 ($63) per outpatient episode. The average cost of hospitalization was RR20,870 ($655/n=500), RR20,925 ($657/n=125) for low-risk, RR20,947 ($657/n=364) for moderate-risk, and RR17,684 ($554/n=11) for high-risk patients; with 60%-80% of patients with CAP hospitalized and the estimated number of CAP patients of age 50 and older in Tver 3,249, the annual cost of CAP to payer is RR53,448,423 (~$1.7million); the national estimates of cost of CAP in senior adults was $124million. Employed patients comprise 12.8% and 18.3% among the inpatient and outpatient cases, respectively, and days lost from work per employed patient was 8.0 (inpatient) and 7.0 (outpatient).  CONCLUSIONS: CAP in adults is a significant cause of resource use and healthcare cost in Russia, inpatient care constitutes the majority of cost. Cost of treatment was similar across all age and risk groups.