Cost Variation in Hospitalized Community-Acquired Pneumonia Patients with Comorbidities: Evidence from a JKN Provider Hospital in Bali, Indonesia

Kadek Hendra Darmawan, I Komang Agus Merta Wirajaya, Dewa Ayu Putu Satrya Dewi, I Gusti Ayu Rai Widowati

Abstract

Community-acquired pneumonia (CAP) is a major cause of hospitalization and imposes substantial costs among patients with comorbidities. This study estimates the direct medical costs of CAP admissions at RSUD Bali Mandara, Bali. The analysis examines variation in cost by comorbidity, treatment class, and length of stay, which currently remains understudied in the Indonesian context. We conducted a cross-sectional analysis of adults diagnosed with CAP who were inpatients treated between January and December 2024. We calculated direct medical costs using a cost-of-illness framework with bottom-up costing based on hospital records and billing. We quantified comorbidities using the Charlson Comorbidity Index (CCI) and compared costs across patient subgroups. Among 31 CAP admissions, the mean hospitalization cost was IDR 8,306,630 ± 2,858,625 per patient (range: IDR 3,815,208–16,336,494). Professional services (28.45%), medications and medical consumables (27.31%), and hospital accommodation (15.92%) were the primary contributors to total costs. Direct costs varied significantly by comorbidity burden (p = 0.032), treatment class (p = 0.024), and length of stay (p = 0.024). In this study, CAP patients with severe comorbidities (CCI ≥4) incurred 72.5% higher costs than those without comorbidities, while hospitalizations longer than 7 days were approximately 2.3 times more costly than stays of 1–3 days. The comorbidity burden, class of care, and length of stay were the principal determinants of direct medical costs in hospitalized CAP patients in Indonesia. This study provides the first local findings in these areas to support risk-stratified cost planning in CAP inpatient care in Indonesia. 

Keywords

Cost of illness; COI; Community-acquired pneumonia; Comorbidities; Jaminan Kesehatan Nasional; Indonesia

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DOI: https://doi.org/10.20961/jpscr.v11i2.112237

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