In 2014, US healthcare spending exceeded $3.0 trillion with nearly 1/3 spent on hospitalizations. Informed by real-world data from an Electronic Health Record (EHR) database of clinical and administrative records spanning 273 million encounters for 60 million patients in 600+ hospitals across the US, Boston Strategic Partners (BSP) Clinical Insights report, Hospital-Treated Pneumonia, estimates 30% of all hospital discharges involve treatment of infectious organisms. Pneumonia is responsible for an estimated 12% of all hospital stays. At an average cost of $15,500 per occurrence, we estimate that hospitalizations for severe infections account for around $212 billion in annual spending or 7% of total healthcare expenditure. In this report, we conduct an in-depth analysis of pneumonia patient characteristics, medication management, costs, and laboratory testing. Hospital-Treated Pneumonia Treatment Report is available at www.bostonsp.com/reports. Gram-negative bacteria are the likely causative agents of most pneumonia infections and physicians treat most of these patients with levofloxacin, ceftriaxone, and azithromycin. Hospital-Treated Pneumonia Treatment is part two of a two-part series on hospital-treated pneumonia. This report provides quantitative, objective data focused on the treatment of pneumonia requiring hospitalization captured by hospitals contributing to Cerner Health Facts. This data provides real-world patient encounters and reflects real physician decisions and encounter characteristics (e.g. patient response to therapy and outcomes) in key areas, such as antimicrobial stewardship.

1. Boston Strategic Partners, Inc.
Business and Clinical Strategy ● Health Economics & Outcomes Research
Medical Communications ● Regulatory Strategy ● Financial Advisory
4 Wellington St. Suite 3, Boston, MA 02118 ● http://www.bostonsp.com ● realworldreports@bostonsp.com ● 617-446-3440
Real World Insights:
Hospital-Treated Pneumonia Part 2: Treatment
July 2017

2. Abstract
In 2014, US healthcare spending exceeded $3.0 trillion with nearly 1/3 spent on hospitalizations. Informed by real-world data from an
Electronic Health Record (EHR) database of clinical and administrative records spanning 273 million encounters for 60 million patients in 600+
hospitals across the US, Boston Strategic Partners estimates 30% of all hospital discharges involve treatment of infectious organisms.
Pneumonia is responsible for an estimated 12% of all hospital stays. At an average cost of $15,500 per occurrence, we estimate that
hospitalizations for severe infections account for around $212 billion in annual spending or 7% of total healthcare expenditure. In this report,
we conduct an in-depth analysis of Pneumonia patient characteristics, medication management, costs, and laboratory testing.
Gram-negative bacteria are the likely causative agents of most Pneumonia infections and physicians treat most of these patients with
levofloxacin, ceftriaxone, and azithromycin.
Hospital-Treated Pneumonia Part 2: Treatment is part two of a two-part series on hospital-treated Pneumonia. This report provides
quantitative, objective data focused on the treatment of Pneumonia requiring hospitalization captured by hospitals contributing to Cerner
Health Facts. This data provides real-world patient encounters and reflects real physician decisions and encounter characteristics (e.g. patient
response to therapy and outcomes) in key areas, such as antimicrobial stewardship.
• Focused on Pneumonia requiring hospitalization, detailed analysis of over 680K hospital discharges from 2009 to 2015 (including
projections through 2019)
• Epidemiology of infection in the US, including demographic information, growth, overall patient encounter attributes, and most common
causative agents
• An overview of patients with Pneumonia in the US, including region, gender, and age breakdown, payer type, infection type, associated
patient comorbidities, and antibiotic usage
• Analysis of mortality, total costs, and admission data and how they correlate with the following:
• Age of patient
• APACHE II score
• Care setting
• Antibiotic usage
• Examination of frequently ordered lab tests and cultures with data on turnaround time (TAT) and results
• Assessment of confirmatory diagnostic results, empiric therapy, and how results impact empiric therapy
• Treatment duration of frequently used antibiotics
2

3. Table of Contents
3
1. Patient Flow
2. Executive Summary
3. Incidence and Impact of Disease
a. Incidence
b. Length of Stay
c. Total Cost
4. Patient Demographics
a. Age
b. Insurance type
c. Gender
d. Region
e. Mortality
f. Comorbid Conditions
5. Patient Flow through the Hospital
a. Admission Site
b. Lab Testing
c. Lab TAT
d. Results
e. Etiology
f. Empiric Therapy
g. Change in treatment
6. Drug Share for Key Therapeutics
a. Most Common
b. LOS
c. APACHE Score
d. Treatment Duration
e. Product Dashboards
i. Market Share
ii. Demographics
iii. Hospitalization
7. Outcomes of Treatment
a. Antibiotic Usage
b. Mortality
c. Cost per Patient
8. Database Overview
9. Methodology

4. Executive Summary
Methodology Overview:
Using an electronic health record (EHR) database with information collected from 614 hospitals across
the US, we evaluated overall trends in the diagnosis, treatment, costs, and outcomes associated with
acute infections requiring hospitalization (n=681,251 patients from 2010-2015). In addition, we
conducted an in-depth analysis for specific types of infections. This report will focus on the treatment
of Pneumonia in the hospital.
Incidence and Impact of Disease:
In 2014, the US healthcare spending crossed $3.0 trillion with nearly 1/3 ($971 billion) spent on
hospitalizations.1 In 2013, an estimated 13.7 million hospital discharges (~30% of all hospital
discharges) involved treatment of infectious organisms.2
At an average cost of $15,500 per occurrence, we estimate that hospitalization for severe infections
account for approximately $212 billion in annual spending (7% of total healthcare expenditure).
Pneumonia accounts for approximately 1.14 MM inpatient stays per year, or ~12% of all hospital stays.
Of these patients, approximately 20% have confirmed bacterial agents as the cause of infection.
4
Source: CMS, 2016, HCUP, 2016, BSP EHR database

5. Piperacillin-tazobactam Dashboard
5
8.90%
Market Share of Piperacillin-tazobactam
Demographics Hospitalization
Median
APACHE II
Score
Gender
Breakdown
Mortality Rate
Median Length
of Stay
AWP Per Dose
Median
Number of
Doses
Duration of
Treatment per
Patient
IV
3.375 g:
$13.20 - $21.75
4.5 g:
$17.60 - $27.55
41 doses per
visit
3.9 Days
Rank*: T-15th
6.0
46.0% Female
54.0% Male
13%
6.9 Days
Rank: 7th
1-9, 0.0% 10-19,
0.4%
20-29,
2.6%
30-39,
3.3%
40-49,
7.7%
50-59,
14.5%
60-69,
19.6%
70-79,
23.4%
80-89,
23.5%
90-99,
4.6%
100+,
0.2%
Source: BSP EHR database (2010 – 2015), RedBook, 2016, Drugs.com, 2016
*Shortest duration has highest rank
Drug

6. The dataset represents 10% of US hospitals and 16% of the US population
with data from over 273MM patient visits
6
Pacific
Hospitals: 43 (7%)
Visits: 23.2 MM
Patients: 4.6 MM (9%)
Mountain
Hospitals: 58 (11%)
Visits: 11.9 MM
Patients: 1.8 MM (8%)
West North Central
Hospitals: 83 (11%)
Visits: 41.5 MM
Patients: 6.5 MM (31%)
East North Central
Hospitals: 80 (9%)
Visits: 19.9 MM
Patients: 3.8 MM (8%)
West South Central
Hospitals: 58 (6%)
Visits: 15.8 MM
Patients: 3.2 MM (8%)
New England
Hospitals: 24 (10%)
Visits: 30.3 MM
Patients: 2.9 MM (19%)
Mid Atlantic
Hospitals: 95 (19%)
Visits: 84.6 MM
Patients: 16.1 MM (39%)
South Atlantic
Hospitals: 42 (5%)
Visits: 7.7 MM
Patients: 1.8 MM (3%)
East South Central
Hospitals: 110 (23%)
Visits: 37.8 MM
Patients: 8.9 MM (47%)
Dataset (% of total US market)
Overall
614 Hospitals
273 MM Patient Visits
56 MM Unique Patients
January 2000 – March 2015
Source: BSP EHR database, HCUP, US Census