{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T00:41:17Z","timestamp":1793320877478,"version":"4.5.0"},"reference-count":30,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2021,11,24]],"date-time":"2021-11-24T00:00:00Z","timestamp":1637712000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Merck Sharp &amp; Dohme Corp., a subsidiary of Merck &amp; Co., Inc., Kenilworth, NJ, USA","award":["NA"],"award-info":[{"award-number":["NA"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Despite the availability of vaccines against Streptococcus pneumoniae, the global incidence and economic cost of pneumococcal disease (PD) among adults is still high. This retrospective cohort analysis estimated the cost of emergency department (ED) visits\/hospitalizations associated with non-invasive pneumonia and invasive pneumococcal disease among individuals \u226515 years of age in the Liguria region of Italy during 2012\u20132018. Data from the Liguria Region Administrative Health Databases and the Ligurian Chronic Condition Data Warehouse were used, including hospital admission date, length of stay, discharge date, outpatient visits, and laboratory\/imaging procedures. A \u226530-day gap between two events defined a new episode, and patients with \u22651 ED or inpatient claim for PD were identified. The total mean annual number of hospitalizations for PD was 13,450, costing ~\u20ac49 million per year. Pneumonia accounted for the majority of hospitalization costs. The median annual cost of hospitalization for all-cause pneumonia was \u20ac38,416,440 (per-capita cost: \u20ac26.78) and was \u20ac30,353,928 (per-capita cost: \u20ac20.88) for pneumococcal and unspecified pneumonia. The total number and associated costs of ED visits\/hospitalizations generally increased over the study period. PD still incurs high economic costs in adults in the Liguria region of Italy.<\/jats:p>","DOI":"10.3390\/vaccines9121380","type":"journal-article","created":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T03:12:56Z","timestamp":1638328376000},"page":"1380","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Economic Burden of Pneumococcal Disease in Individuals Aged 15 Years and Older in the Liguria Region of Italy"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4683-1945","authenticated-orcid":false,"given":"Matteo","family":"Astengo","sequence":"first","affiliation":[{"name":"Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Paganino","sequence":"additional","affiliation":[{"name":"Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9707-5214","authenticated-orcid":false,"given":"Daniela","family":"Amicizia","sequence":"additional","affiliation":[{"name":"Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4633-202X","authenticated-orcid":false,"given":"Cecilia","family":"Trucchi","sequence":"additional","affiliation":[{"name":"Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy"},{"name":"Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3114-8043","authenticated-orcid":false,"given":"Federico","family":"Tassinari","sequence":"additional","affiliation":[{"name":"Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilla","family":"Sticchi","sequence":"additional","affiliation":[{"name":"Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Sticchi","sequence":"additional","affiliation":[{"name":"Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2433-9610","authenticated-orcid":false,"given":"Andrea","family":"Orsi","sequence":"additional","affiliation":[{"name":"Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8463-8487","authenticated-orcid":false,"given":"Giancarlo","family":"Icardi","sequence":"additional","affiliation":[{"name":"Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2404-3609","authenticated-orcid":false,"given":"Maria Francesca","family":"Piazza","sequence":"additional","affiliation":[{"name":"Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Di Silverio","sequence":"additional","affiliation":[{"name":"Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arijita","family":"Deb","sequence":"additional","affiliation":[{"name":"Merck & Co., Inc., Kenilworth, NJ 07033, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Senese","sequence":"additional","affiliation":[{"name":"MSD Italy, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gian Marco","family":"Prandi","sequence":"additional","affiliation":[{"name":"MSD Italy, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo","family":"Ansaldi","sequence":"additional","affiliation":[{"name":"Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy"},{"name":"Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,24]]},"reference":[{"key":"ref_1","unstructured":"Centers for Disease Control and Prevention (2021, September 22). Pneumococcal Disease-Types of Infection, Available online: https:\/\/www.cdc.gov\/pneumococcal\/about\/infection-types.html."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1128\/CMR.00018-12","article-title":"Pediatric invasive pneumococcal disease in the United States in the era of pneumococcal conjugate vaccines","volume":"25","author":"Tan","year":"2012","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_3","unstructured":"GBD 2016 Lower Respiratory Infections Collaborators (2018). Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990\u20132016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis., 18, 1191\u20131210."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3398","DOI":"10.1016\/j.vaccine.2011.02.088","article-title":"Healthcare utilization and cost of pneumococcal disease in the United States","volume":"29","author":"Huang","year":"2011","journal-title":"Vaccine"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Song, J.Y., Choi, J.Y., Lee, J.S., Bae, I.-G., Kim, Y.K., Sohn, J.W., Jo, Y.M., Choi, W.S., Lee, J., and Park, K.H. (2013). Clinical and economic burden of invasive pneumococcal disease in adults: A multicenter hospital-based study. BMC Infect Dis., 13.","DOI":"10.1186\/1471-2334-13-202"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1001\/jamainternmed.2016.8289","article-title":"Developing better pneumococcal vaccines for adults","volume":"177","author":"Weinberger","year":"2017","journal-title":"JAMA Intern. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1093\/aje\/kwv283","article-title":"Relating Pneumococcal Carriage Among Children to Disease Rates Among Adults Before and After the Introduction of Conjugate Vaccines","volume":"183","author":"Weinberger","year":"2016","journal-title":"Am. J. Epidemiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1159\/000504490","article-title":"Vaccines to Protect Older Adults against Pneumococcal Disease","volume":"43","author":"Knol","year":"2020","journal-title":"Interdiscip. Top. Gerontol. Geriatr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1007\/s10096-016-2834-2","article-title":"Changes in the pneumococcal disease-related hospitalisations in Spain after the replacement of 7-valent by 13-valent conjugate vaccine","volume":"36","author":"Georgalis","year":"2017","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3459","DOI":"10.1016\/j.vaccine.2009.01.052","article-title":"Universal childhood immunisation against Streptococcus pneumoniae: The five-year experience of Liguria Region, Italy","volume":"27","author":"Durando","year":"2009","journal-title":"Vaccine"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Orsi, A., Ansaldi, F., Trucchi, C., Rosselli, R., and Icardi, G. (2016). Pneumococcus and the elderly in Italy: A summary of available evidence regarding carriage, clinical burden of lower respiratory tract infections and on-field effectiveness of PCV13 vaccination. Int. J. Mol. Sci., 17.","DOI":"10.3390\/ijms17071140"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1255","DOI":"10.1177\/147323000803600612","article-title":"Decline in pneumonia and acute otitis media after the introduction of childhood pneumococcal vaccination in Liguria, Italy","volume":"36","author":"Ansaldi","year":"2008","journal-title":"J. Int. Med. Res."},{"key":"ref_13","unstructured":"Ministero della Salute (2021, September 22). DGPRV 0024720-P-27\/05\/2010. Indicazioni in Merito alla Somministrazione del Vaccino Antipneumococcico Prevenar 13 in et\u00e0 Pediatrica. Available online: https:\/\/www.fimpcalabria.org\/public\/vaccinazioni\/indicazioni%20in%20merito%20alla%20somministrazione%20del%20vaccino%20antipneumococcico%20prevenar%2013%20in%20et%C3%A0%20pediatrica%20(2).pdf."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"211","DOI":"10.4161\/hv.7.0.14602","article-title":"Epidemiological changes after PCV7 implementation in Italy: Perspective for new vaccines","volume":"7","author":"Ansaldi","year":"2011","journal-title":"Hum. Vaccin."},{"key":"ref_15","unstructured":"(2021, September 22). EpiCentro Epidemiology for Public Health. Vaccinations in Italy. Available online: https:\/\/www.epicentro.iss.it\/vaccini\/dati_Ita."},{"key":"ref_16","first-page":"66","article-title":"Immunization campaign with 13-valent Pneumococcal Conjugate Vaccine in adults in Liguria Region, Italy: One year post-introduction preliminary results","volume":"38","author":"Orsi","year":"2014","journal-title":"Epidemiol. Prev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s41479-017-0039-9","article-title":"Community-acquired pneumonia in the United Kingdom: A call to action","volume":"9","author":"Chalmers","year":"2017","journal-title":"Pneumonia (Nathan)"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.rmed.2018.02.007","article-title":"Burden of pneumococcal community-acquired pneumonia in adults across Europe: A literature review","volume":"137","author":"Torres","year":"2018","journal-title":"Respir. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e187","DOI":"10.1017\/S0950268820001077","article-title":"Impact of vaccination on invasive pneumococcal disease in Italy 2007\u20132017: Surveillance challenges and epidemiological changes","volume":"148","author":"Monali","year":"2020","journal-title":"Epidemiol. Infect."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3670","DOI":"10.1080\/21645515.2021.1923348","article-title":"Burden of pneumococcal disease among adults in Southern Europe (Spain, Portugal, Italy, and Greece): A systematic review and meta-analysis","volume":"17","author":"Montuori","year":"2021","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12913-019-4412-7","article-title":"Hospital and economic burden of influenza-like illness and lower respiratory tract infection in adults \u226550 years-old","volume":"19","author":"Trucchi","year":"2019","journal-title":"BMC Health Serv. Res."},{"key":"ref_22","unstructured":"Ministero della Salute (2021, September 22). Supplemento Ordinario n. 8 alla GAZZETTA UFFICIALE 28.01.2013-Serie Generale-n. 23, Available online: https:\/\/www.trovanorme.salute.gov.it\/norme\/renderPdf.spring?seriegu=SG&datagu=28\/01\/2013&redaz=13A00528&artp=1&art=1&subart=1&subart1=10&vers=1&prog=001."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1080\/21645515.2017.1264796","article-title":"Hospitalizations for pneumonia, invasive diseases and otitis in Tuscany (Italy), 2002\u20132014: Which was the impact of universal pneumococcal pediatric vaccination?","volume":"13","author":"Boccalini","year":"2017","journal-title":"Hum. Vaccin. Immunother."},{"key":"ref_24","first-page":"1900","article-title":"Risk of hospitalization due to pneumococcal disease in adults in Spain. The CORIENNE study","volume":"12","author":"Walter","year":"2016","journal-title":"Hum. Vaccin. Immunother."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2124","DOI":"10.1377\/hlthaff.2016.0462","article-title":"Modeling the economic burden of adult vaccine-preventable diseases in the United States","volume":"35","author":"Ozawa","year":"2016","journal-title":"Health Aff. (Millwood)"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Weycker, D., Farkouh, R.A., Strutton, D.R., Edelsberg, J., Shea, K.M., and Pelton, S.I. (2016). Rates and costs of invasive pneumococcal disease and pneumonia in persons with underlying medical conditions. BMC Health Serv. Res., 16.","DOI":"10.1186\/s12913-016-1432-4"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1093\/oxfordjournals.aje.a009804","article-title":"Accuracy of ICD-9-CM codes in detecting community-acquired pneumococcal pneumonia for incidence and vaccine efficacy studies","volume":"149","author":"Guevara","year":"1999","journal-title":"Am. J. Epidemiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1016\/j.jclinepi.2006.10.018","article-title":"International classification of diseases codes showed modest sensitivity for detecting community-acquired pneumonia","volume":"60","author":"Oosterheert","year":"2007","journal-title":"J. Clin. Epidemiol."},{"key":"ref_29","unstructured":"Agenzia per l\u2019Italia Digitale (2021, November 09). Fascicolo Sanitario Elettrronico ICD-9-CM 5 August 2021, Available online: https:\/\/www.fascicolosanitario.gov.it\/en\/ICD-9-CM."},{"key":"ref_30","unstructured":"(2021, November 22). Regional Law 29\/07\/2016, n.17. Istituzione dell\u2019Azienda Ligure Sanitaria della Regione Liguria (A.Li.Sa.) e Indirizzi per il Riordino delle Disposizioni Regionali in Materia Sanitaria e Sociosanitaria. Bollettino Ufficiale n.15, 30\/07\/2016. Available online: http:\/\/lrv.regione.liguria.it\/liguriass_prod\/articolo?urndoc=urn:nir:regione.liguria:legge:2016-07-29;17&pr=idx,0;artic,1;articparziale,0."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/9\/12\/1380\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:35:02Z","timestamp":1760168102000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/9\/12\/1380"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,24]]},"references-count":30,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["vaccines9121380"],"URL":"https:\/\/doi.org\/10.3390\/vaccines9121380","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,24]]}}}