Children With Chronic Conditions Face Higher Pneumococcal Disease Costs

A retrospective cohort study using the Merative MarketScan Commercial Database and Multi-State Medicaid Databases found that US children with chronic medical conditions (CMC) or immunocompromising (IC) experience substantially higher health care resource utilization and costs from pneumococcal disease than children without those conditions, across all age groups and both insurance types.¹

The study, published in Pneumonia, analyzed claims from 2018 to 2023 among children younger than 18 years with full-year continuous enrollment, examining invasive pneumococcal disease (IPD), all-cause pneumonia (ACP), and acute otitis media (AOM) episodes stratified by risk group.¹

Invasive Disease Drives the Steepest Costs

Among commercially insured children, 423 had at least 1 IPD episode during the study period, and 664 Medicaid-insured children did. Inpatient days per IPD episode were longer among children with CMC (mean, 12.7 days) or IC (mean, 11.9 days) than among those with no CMC/IC (mean, 6.2 days).¹

Total treatment costs per IPD episode were more than 3-fold higher among commercially insured children with CMC ($76,278) or IC ($72,130) compared with those with no CMC/IC ($22,371). Medicaid-insured children with CMC ($17,389) or IC ($19,945) incurred more than double the costs of those with no CMC/IC ($6,476).¹

A sensitivity analysis restricted to IPD episodes requiring hospitalization—63% of commercial and 65% of Medicaid IPD episodes—found even higher costs, reaching $119,583 among commercially insured children with IC.¹

Pneumonia and Ear Infections Show the Same Pattern

The pattern held for less severe manifestations. Total cost per ACP episode was highest among children with IC (commercial, $7,343; Medicaid, $3257), followed by those with CMC (commercial, $2637; Medicaid, $1160), and lowest among children with no CMC/IC (commercial, $809; Medicaid, $356).¹

Inpatient admissions for ACP were also more common among commercially insured children with IC (12.3%) than those with CMC (6.4%) or no CMC/IC (1.7%).¹

For AOM, costs followed the same order—highest in children with IC ($608 commercial; $178 Medicaid), followed by CMC ($442; $141), and lowest in children with no CMC/IC ($368; $123)—and AOM-related surgical procedures were more frequent among children with IC or CMC than those without underlying conditions.¹

Risk Persists Beyond Early Childhood

Pneumococcal disease prevention efforts have traditionally targeted children younger than 5 years, but the study found that a substantial proportion of episodes occurred in older children, a pattern more pronounced among those with CMC or IC.¹

This aligns with broader estimates from the National Foundation for Infectious Diseases (NFID), which reports that approximately 6.8 million children and adolescents aged 2 to 18 years in the United States have chronic health conditions or immune-weakening conditions—including cancer, sickle cell disease, diabetes, or chronic heart, lung, liver, or kidney disorders—that place them at high risk for pneumococcal disease and related complications.²

A separate review of pneumococcal infection in children similarly identifies chronic medical conditions, humoral immunodeficiency, splenic dysfunction, HIV, nephrotic syndrome, and chronic lung disease among the risk factors for frequent and severe infection.³

Implications for Vaccination and Pharmacy Practice

The study's authors noted that their findings support risk-based pneumococcal vaccination recommendations that extend beyond early childhood for children with CMC or IC.¹

The NFID currently recommends pneumococcal conjugate vaccine (PCV15 or PCV20) for children younger than 5 years without prior vaccination, along with additional pneumococcal vaccination for children aged 6 to 18 years who have qualifying chronic or immune-weakening conditions, in consultation with a health care professional.²

A related population-based study from British Columbia, Canada, found that direct health care costs for IPD and AOM declined in the years following the introduction of the 13-valent pneumococcal conjugate vaccine into the infant immunization program, even as pneumonia-related costs continued to rise.⁴

Pharmacists involved in immunization services and chronic disease management are positioned to help identify children with qualifying risk conditions and ensure they receive recommended pneumococcal vaccines beyond the standard infant series.

REFERENCES

1. Mohanty S, Done N, Song Y, et al. 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. Pneumonia (Nathan). 2026;18(1):20. Published 2026 Sep 5. doi:10.1186/s41479-026-00206-1
2. National Foundation for Infectious Diseases. Pneumococcal disease and children. NFID. Updated November 2025. Accessed September 10, 2026. https://www.nfid.org/infectious-diseases/pneumococcal-disease-and-children/

3. Thadchanamoorthy V, Dayasiri K. Review on Pneumococcal Infection in Children. Cureus. 2021;13(5):e14913. Published 2021 May 9. doi:10.7759/cureus.14913

4. Vadlamudi NK, Sadatsafavi M, Patrick DM, Rose C, Hoang L, Marra F. Healthcare Costs for Pneumococcal Disease in the Era of Infant Immunization With 13-Valent Pneumococcal Conjugate Vaccine: A Population-Based Study. Value Health. 2022;25(9):1510-1519. doi:10.1016/j.jval.2022.03.017