Hospitalized low-risk community-acquired pneumonia: outcome and potential for cost-savings

In the USA, a group of low-risk patients with community-acquired pneumonia (CAP) with a low risk of mortality were identified and it was suggested that they may be treated as outpatients to save costs. We evaluated the outcome of these low-risk CAP patients that were hospitalized in our local setting, and gauged the number of such patients in order to estimate the potential cost-savings by treating them as out-patients, as well as the safety of such an approach.

All patients with CAP admitted to the National University Hospital, Singapore, from 1 April to 1 November 1997 were enrolled into a prospective cohort study. Low-risk patients were identified, and their hospital outcomes were compared with the other patients. Hospitalization charges were obtained from the Finance Department.

There were 155 CAP patients (69 females and 86 males). The age was 56.6 +/- 22.2 years, ranging from 12 to 93 years old. The average hospital stay was 8.4 +/- 11 days. Mortality was 12.9%. There were 37 (24%) low-risk CAP patients, and there was no mortality in this group. No low-risk patient required mechanical ventilation. They had a significantly shorter hospital stay compared with high-risk patients. An identifiable organism was found in 27% of the low-risk CAP with only one patient having a positive blood culture. The average hospitalization charge for low-risk CAP patients was, as expected, significantly lower than for the high-risk patients, and was 11.9% of the total cost for hospitalized CAP patients.

Nearly one-quarter of our CAP admissions consisted of low-risk patients that had no mortality, and required a significantly shorter hospitalization period. The management of such patients who are young (< or = 50 years), and had no serious coexisting conditions in an out-patient setting, may lead to significant cost-savings as the average hospitalization charge was US$1295 and 11.9% of total hospitalization charges for CAP.