Healthcare resource utilization and cost of invasive pneumococcal disease, pneumonia, and acute otitis media in commercially and medicaid-insured children by risk group in the United States, 2018 to 2023.

backgroundPneumococcal disease (PD) is a leading cause of morbidity among US children, particularly those with chronic medical conditions (CMC) and immunocompromising conditions (IC), and the decline in PD incidence was less pronounced in the late pneumococcal conjugate vaccine (PCV) 13 period. This study quantified healthcare resource utilization (HCRU) and costs among commercially and Medicaid-insured children with PD.

methodsThis retrospective observational cohort study used Merative™ MarketScan® Commercial Database and Multi-State Medicaid Databases to identify children with invasive pneumococcal disease (IPD), all-cause pneumonia (ACP), and acute otitis media (AOM) episodes using inpatient and outpatient claims. HCRU and costs per PD episode were assessed in the commercially and Medicaid-insured populations, stratified by age (<2, 2-4, and 5-17 years) and risk group (CMC, IC, and no CMC/IC).

resultsBetween 2018 and 2023, commercially insured children contributed 23.6 million person-years (PY) and Medicaid-insured children contributed 23.4 million PY; 423 and 664 children had IPD, 309,540 and 281,569 had ACP, and 2,721,354 and 2,596,201 had AOM in the commercial and Medicaid populations, respectively. In both databases, HCRU and cost was higher in children with CMC or IC, compared to no CMC/IC across age groups for all PD manifestations. For IPD and ACP, inpatient admissions were 1.4 to 2.2-fold longer for children with CMC or IC. For IPD, costs per episode were 2-to-3-fold higher in children with CMC or IC, compared with those without CMC/IC (Commercial: $76,278 and $72,130 vs. $22,371; Medicaid: $17,389 and $19,945 vs. $6,476, respectively). For ACP, costs were highest in children with IC, followed by CMC and no CMC/IC (Commercial: $7,343, $2,637, and $809; Medicaid: $3,257, $1,160, and $356, respectively). AOM showed a similar pattern, with highest costs in children with IC (Commercial: $608; Medicaid: $178), followed by CMC ($442; $141), and lowest in those without CMC/IC ($368; $123).

conclusionsUS children with underlying conditions that increase susceptibility to PD experience substantially higher HCRU and costs compared with those without such conditions, across all PD manifestations, regardless of insurance type and age group. These findings underscore the need for risk-based prevention strategies, including vaccination, beyond early childhood in high-risk pediatric populations.