Economic burden of invasive pneumococcal disease in hospitalized children in Zhejiang Province, China: A multicenter hospital-based study conducted from 2014-2024

Abstract

To evaluate the clinical and economic outcomes in pediatric patients hospitalized with invasive pneumococcal disease (IPD). This is a retrospective study that included hospitalized patients under 18 years of age from three participating hospitals between 2014 and 2024, all of whom had a definitive diagnosis and laboratory confirmation of invasive pneumococcal disease (IPD). Descriptive statistics and multivariable analyses were used to evaluate outcome measures, including in-hospital mortality, length of stay (LOS), direct cost per admission and vaccination status, and the serotypes were also explored. A total of 141 pediatric patients from January 2014 to July 2024 were included. Of these, 83 (58.9%) were male, and 72 (51.5%) were aged 2-5 years. Forty-one (29.1%) patients required hospitalization for over 14 days, and 3 (2.1%) had received vaccination. Among the 97 serotypes identified, 86 (88.7%) were PCV13 vaccine-type serotypes (VT-Serotypes). The most common disease was bacteremia (54.6%), followed by bacteremic pneumonia (23.4%). The observed mortality, median LOS, and median direct cost were 0.7%, 8 days, and $1122.66 (based on the RMB-USD exchange rate in 2025), respectively. Factors influencing cost included LOS and the type of IPD. Longer LOS, influenced by IPD types, was associated with higher costs, and patients diagnosed with meningitis incurred greater costs per admission compared to those with bacteremia. IPD poses a significant clinical and economic burden on children. Promoting pneumococci vaccination is essential to mitigate the IPD burden and associated costs in China.

Keywords: Costs; Streptococcus pneumoniae; hospitalization; invasive pneumococcal disease.

Figure 1.

LOS and Cost for ipd patients by diagnosis. Box: median with 25th and 75th percentiles; whiskers: upper/lower adjacent values; data points: outside values.