The aim of this study was to investigate treatment failure (TF) in hospitalised community-acquired pneumonia (CAP) patients with regard to initial antibiotic treatment and economic impact.CAP patients were included in two open, prospective multicentre studies assessing the direct costs for in-patient treatment. Patients received treatment either with moxifloxacin (MFX) or a nonstandardised antibiotic therapy. Any change in antibiotic therapy after .72h of treatment to a broadened antibiotic spectrum was considered as TF.Overall, 1,236 patients (mean¡SD age 69.6¡16.8 yrs, 691 (55.9%) male) were included. TF occurred in 197 (15.9%) subjects and led to longer hospital stay (15.4¡7.3 days versus 9.8¡4.2 days; p,0.001) and increased median treatment costs (J2,206 versus J1,284; p,0.001). 596 (48.2%) patients received MFX and witnessed less TF (10.9% versus 20.6%; p,0.001). After controlling for confounders in multivariate analysis, adjusted risk of TF was clearly reduced in MFX as compared with b-lactam monotherapy (adjusted OR for MFX 0.43, 95% CI 0.27-0.68) and was more comparable with a b-lactam plus macrolide combination (BLM) (OR 0.68, 95% CI 0.38-1.21).In hospitalised CAP, TF is frequent and leads to prolonged hospital stay and increased treatment costs. Initial treatment with MFX or BLM is a possible strategy to prevent TF, and may thus reduce treatment costs.
ZusammenfassungZielsetzung: Ziel der vorliegenden Modellrechnung ist der Vergleich der Kosten-Effektivität der Antibiotika-Therapien mit Moxifloxacin, Gatifloxacin, Levofloxacin und Telithromycin bei akuten Exazerbationen der chronischen Bronchitis. Verschiedene klinische Studien weisen für die betrachteten Arzneimittel Therapieerfolgsraten zwischen 89,2 % und 94,0 % aus. Methodik: Die Modellrechnung wird als Kosten-Effektivitäts-Analyse durchgeführt. Die gewählte Perspektive ist diejenige der Gesundheitspolitik; sie umfasst sowohl die direkten Kosten als auch indirekte Kosten. Ergebnisse: Die Ergebnisse der Modellrechnung zeigen bei den untersuchten Alternativen teilweise deutlich unterschiedliche effektivitätsadjustierte direkte Kosten. Mit 59,32 E je erfolgreich behandeltem Patienten stellt die Therapie mit Moxifloxacin die kosteneffektivste Alternative dar. Levofloxacin weist bei einer geringfügig höheren Therapieerfolgsrate auch etwas höhere Kosten je erfolgreich behandeltem Patienten auf. Schlussfolgerung: Eine effiziente antibiotische Therapie bei Patienten mit akuter bakterieller Exazerbation der chronischen Bronchitis ist allgemein als notwendig anerkannt. Verschiedene Alternativen stehen dem behandelnden Arzt zur Verfügung, der bei seinen Verordnungen heute auch den Aspekt der Wirtschaftlichkeit berücksichtigen muss. Die Wirtschaftlichkeit einer Therapie hängt in diesem Zusammenhang nicht allein von den Arzneimittelpreisen ab, wie die vorliegende Modellrechnung zeigt. Der Nutzen, die Effektivität der Therapie, muss ebenso wie die Therapiekosten berücksichtigt werden.
AbstractAim: The aim of this model is to compare the cost-effectiveness of the antibiotic therapies with moxifloxacin, gatifloxacin, levofloxacin and telithromycin. Various clinical trials indicate success rates between 89.2 % and 94.0 % for these antibiotics. Method: The model is designed as a cost-effectiveness-analysis taken from the health politicians' perspective. Direct medical costs as well as indirect economic costs are considered. Results: The model partially indicates significant variations in adjusted direct costs. Moxifloxacin therapy proved the most cost-effective alternative with adjusted direct costs amounting to E 59.32 for each successfully treated patient. For the levofloxacin therapy, slightly higher costs were observed, but the success rate was also slightly superior to that of moxifloxacin. Conclusion: Efficient antibiotic therapy is generally accepted as an indispensable treatment for patients suffering from acute bacterial exacerbations of chronic bronchitis. The physician has a choice between various antibiotic alternatives but has to consider the economic aspects nowadays before prescribing an antibiotic treatment. The economic feasibility of a therapy not only depends on drug costs; the effectiveness plays an equally important role.
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