Estimating the economic impact of a half-day reduction in length of hospital stay among patients with community-acquired pneumonia in the US

ABSTRACT

Background: A recent study suggested that levofloxacin significantly reduces the hospital length of stay (LOS), by 0.5 days (p?=?0.02), relative to moxifloxacin in patients with community-acquired pneumonia (CAP). The current analysis evaluated the potential economic impact of this half-day reduction in LOS.

Methods: A cost model was developed to estimate the impact of a half-day reduction in LOS for CAP hospitalizations in the US. CAP incidence, hospitalization rate, and costs were obtained from published studies in PubMed and from publicly available government sources. The average daily cost of hospitalization was estimated for fixed costs, which comprise 59% of total inpatient costs. Costs from prior years were inflated to 2007 US dollars using the consumer price index. A range of cost savings, calculated using inpatient CAP costs from several studies, was extrapolated to the US CAP population.

Results: Using the Centers for Disease Control National Hospital Discharge estimate of 5.3 days LOS for CAP, and an average cost (2007 $US) of $13,009 per CAP hospitalization, a daily fixed cost of $1448 was estimated. The resultant half-day reduction in costs associated with LOS was $724/hospitalization (range $457 to $846/hospitalization). When fixed and variable costs were considered, the estimated savings were $1227.27/episode. The incidence of CAP was estimated to be 1.9% (5.7 million cases/year based on current population census), and the estimated rate of CAP hospitalization was 19.6% (1.1 million annual hospitalizations). At $13,009/CAP-related hospitalization, total fixed inpatient costs of $8.6 billion annually were projected. The half-day reduction in LOS would therefore generate potential annual savings of approximately $813 million (range $513 million to $950 million). When total costs (fixed plus variable) were estimated, the mean savings for a half-day reduction would be approximately $1227/episode (range of $775 to $1434) or $1.37 billion annually in the US CAP population (range of $871 million to $1.6 billion). Limitations include the use of a single study for the estimation of fixed costs but a diversity of sources used for estimates of other variables, and lack of data with respect to the effects on costs of diagnostic-related groups, discounted contracts, and capitated payments.

Conclusions: A relatively small decrease in LOS in CAP can have a substantial cost impact, with estimated savings of $457 to $846 per episode or $500-$900 million annually. Additional evaluation is warranted for interpreting these cost-savings in the context of current antibiotic prescribing patterns.     

Hospital visits and costs following outpatient treatment of CAP with levofloxacin or moxifloxacin

Abstract

Background:

Hospital admissions (inpatient and emergency room) are a major source of medical costs for community-acquired pneumonia (CAP) initially treated in the outpatient setting. Current CAP treatment guidelines do not differentiate between outpatient treatment with levofloxacin and moxifloxacin.     

成人社区获得性肺炎患者住院时间的影响因素分析

目的综合分析影响成人社区获得性肺炎（CAP）患者平均住院时间的临床及非临床因素。方法回顾性分析2002年1月至2006年1月我院收治的成人CAP患者的临床资料,根据Fine危险分级标准分为低危组（Ⅰ～Ⅲ级）和高危组（Ⅳ～Ⅴ级）。分析2组住院时间延长者的影响因素。结果共计302例成人CAP患者人选。其中111例（36．8％）处于Fine危险分级Ⅰ～Ⅲ级,191例（63．2％）处于Ⅳ～Ⅴ级。总体住院时间2～47d,平均10．5d。Ⅰ～Ⅲ级的低危患者平均住院时间7．5d,Ⅳ～Ⅴ级高危患者为11．5d。肺炎相关因素和非临床因素导致住院时间延长的患者比例在低危组显著高于高危组（P〈0．05）。而出现并发症和基础疾病恶化导致住院时间延长的患者比例在高危组显著高于低危组（P〈0．05）。结论目前我国成人CAP患者的平均住院时间仍高于国外水平。除了稳定基础疾病和防治并发症外,必须捉商医疗服务质量,减少非临床因素导致的非必要住院时问。     

莫西沙星治疗国内社区获得性肺炎的Meta分析

目的利用Meta分析方法对莫西沙星治疗国内社区获得性肺炎(CAP)的临床试验进行分析,评价其治疗效果。方法检索2002-2010年在国内生物医学期刊发表的有关莫西沙星治疗社区获得性肺炎的临床研究文献,采用Review Manager 4.2软件对符合条件的文献进行荟萃分析。结果共有19个临床试验纳入本次研究,同质性检验χ2=0.30,P>0.05,故采用固定效应模型进行分析。与对照组比较,莫西沙星治疗社区获得性肺炎总有效率更高,比值比为1.94,95%可信区间为1.32～2.84(P<0.05)。结论临床可选用莫西沙星治疗社区获得性肺炎。     

莫西沙星治疗成人社区获得性肺炎的效果分析

目的观察莫西沙星治疗成人社区获得性肺炎(CAP)的有效性和安全性。方法 60例CAP患者随机分为治疗组和对照组各30例,治疗组给予莫西沙星治疗,对照组给予左氧氟沙星治疗,疗程均为1～2周。观察比较2组的临床疗效、细菌清除率及不良反应。结果治疗组总有效率为86.7%高于对照组的70.0%;治疗组细菌清除率为96.2%高于对照组的88.9%,差异均有统计学意义(P<0.05)。2组均未发生严重不良反应。结论莫西沙星用于成人CAP疗效显著,安全性高,值得临床推广应用。     

莫西沙星与左氧氟沙星治疗社区获得性肺炎对比研究

目的 观察莫西沙星与左氧氟沙星治疗社区获得性肺炎的临床疗效及安全性。方法将65例社区获得性肺炎患者随机分成治疗组33例和对照组32例，治疗组给予莫西沙星针剂治疗，400mg静脉滴注，每日1次；对照组给予左氧氟沙星针剂治疗，400mg静脉滴注，每日1次；疗程均为7d。结果 研究结果显示，治疗组和对照组的临床有效率分别为90．91％和87．50％；细菌清除率分别为90．91％和83．33％；不良反应发生率分别为18．18％和21．88％。两组间临床有效率、细菌清除率、不良反应发生率均无显著差异（P〉0．05）。结论 莫西沙星针剂治疗社区获得性肺炎安全有效。     

莫西沙星治疗老年患者社区获得性肺炎的疗效

目的观察莫西沙星治疗老年患者社区获得性肺炎（CAP）的疗效及安全性。方法选择本院老年患者80例,随机分成莫西沙星组（实验组）40例和头孢曲松联合左氧氟沙星组（对照组）40例。结果实验组总有效率95%、对照组总有效率77.5%,两组比较有统计学差异（P〈0.05）。实验组的不良反应发生率7.5%,对照组的不良反应发生率10.0%,两组比较差异无统计学意义（P〉0.05）。结论莫西沙星治疗老年CAP安全、有效。     

莫西沙星序贯疗法治疗社区获得性肺炎疗效分析

目的：评价莫西沙星序贯疗法治疗社区获得性肺炎的疗效。方法：对42例社区获得性肺炎（CAP）患者，采用莫西沙星治疗，静点0．4g·d^-1，持续3～5d，继之口服0．4g·d^-1，维持5～7d。结果：痊愈29例（69％），显效10例（23．8％），有效率92．8％，细菌消除率87．1％，总疗程8～12d，药物副作用较小。结论：莫西沙星序贯疗法治疗社区获得性肺炎疗效高，毒副作用小，疗程较短。     

A cost-minimisation analysis comparing moxifloxacin with levofloxacin plus ceftriaxone for the treatment of patients with community-acquired pneumonia in Germany: results from the MOTIV trial

ABSTRACT

Objective: This study presents a cost-minimisation analysis of moxifloxacin compared to combination treatment with levofloxacin and ceftriaxone in patients hospitalised with community-acquired pneumonia (CAP) in Germany.

Research design and methods: In the MOTIV study, 738 adult patients with CAP requiring hospitalisation and initial parenteral antibiotic therapy were randomised to sequential IV/oral therapy with either moxifloxacin (n?=?368), or levofloxacin and ceftriaxone (n?=?365). The primary effectiveness endpoint was the proportion of patients demonstrating clinical improvement 5–7 days after the completion of study treatment. Subgroup analysis considered patients with severe CAP according to pneumonia severity index (PSI) risk class IV and V, microbiologically proven infection, a history of chronic obstructive pulmonary disease, and a history of cardiovascular disease. The analysis included the cost of study medication, hospital stay, readmission and inpatient procedures and diagnostics. Event frequency in the study was multiplied by German unit costs to estimate per-patient expenditure. The analysis was conducted from a hospital perspective. Sensitivity analysis investigated the effect of costing from an insurer perspective.

Results: No significant difference was found in the percentage of successfully treated patients. Average per patient cost was €2190 for the moxifloxacin group, and €2619 for the levofloxacin + ceftriaxone group (difference –€430, 95% CI: –€138, –€740; p?<?0.05). Variability in total costs was wide, with some patients accruing up to €18?000. Medication cost was significantly lower with moxifloxacin than levofloxacin + ceftriaxone (–€470, 95% CI: –€522, –€421), and accounted for between 15 and 30% of total costs.

Conclusions: In this analysis of patients hospitalised with CAP in Germany, treatment with moxifloxacin was significantly less costly than treatment with levofloxacin and ceftriaxone.     

左氧氟沙星在重症社区获得性肺炎患者中的药物动力学研究

目的:比较左氧氟沙星治疗重症肺炎的不同用药方案的药物动力学差异,为临床合理用药提供依据.方法:24例成人重症社区获得性肺炎且正在接受机械通气的患者分为两组(n=12),分别每日1次或2次静脉滴注左氧氟沙星500 mg,同时每日滴注1次拉维酸1 g,连续静脉滴注10 d,经过2d的治疗达到稳定状态后利用高效液相色谱法测定血浆和上皮细胞衬液中左氧氟沙星的浓度,并比较两组间药动学参数.结果:每日滴注1次的患者,左氧氟沙星的血浆值浓度和上皮细胞衬液浓度分别为(12.6±2.3) mg/L和(11.9±2.7) mg/L,每日滴注2次的患者分别为(19.7±1.8) mg/L和(17.8±1.7) mg/L,这表明左氧氟沙星在肺组织的穿透率都大于100％.每日滴注1次和2次的患者全身暴露浓度(AUC24h)分别为(151.2±12.8) mg· h· L-1和(208.6±15.1) mg· h· L-1,均高于常见重症肺炎致病菌的最小抑菌浓度(MIC).每日滴注1次组的治疗成功率为83％(10/12),每日滴注2次组为92％(11/12),无统计学差异(P＞0.05).结论:对因重症社区获得性肺炎接受机械通气的危重患者,每日静脉滴注500mg左氧氟沙星1次或2次均能达到最小的抑菌浓度.     

Evidence for moxifloxacin in community-acquired pneumonia: the impact of pharmaco-economic considerations on guidelines

Abstract

Objective:

In an era of limited resources, policy makers and health care payers are concerned about the costs of treatment in addition to its effectiveness. However, guidelines do not tend to consider the cost-effectiveness of treatment options. This paper aims to conduct an international literature review with a view to assessing the impact of pharmaco-economic considerations of CAP treatment with moxifloxacin on recent guidelines.     

莫西沙星与左氧氟沙星治疗社区获得性肺炎的随机对照研究

目的评价莫西沙星注射液与左氧氟沙星注射液在治疗社区获得性肺炎中的临床疗效和安全性。方法采用区组随机、开放、阳性药物对照的研究方法。结果治疗结束后d7,PP分析：试验组和对照组的临床有效率分别为97．0％和92．1％;细菌清除率：PP／MBE分析两组分别为96．0％和96．7％。安全性分析：试验组和对照组的不良反应发生率均为20％。上述结果经统计学检验两组比较均无显著性差异（P〉0．05）。结论莫西沙星注射液和左氧氟沙星注射液治疗社区获得性肺炎安全、有效。     

莫西沙星与罗氏芬治疗老年社区获得性肺炎临床疗效比较

目的比较莫西沙星与罗氏芬（头孢曲松钠）治疗老年社区获得性肺炎（CAP）的临床疗效。方法 82例老年CAP患者随机分为观察组（43例）和对照组（39例）。对照组用罗氏芬2.0 g加入250 ml生理盐水中静脉滴注,1次/d。观察组用盐酸莫西沙星氯化钠0.4 g,静脉滴注,1次/d,两组疗程均为7 d。观察两组的治疗情况。结果观察组发热、肺部啰音及胸片炎性影消失时间与对照组比较差异有统计学意义（P〈0.01）,两组咳嗽消失时间比较差异有统计学意义（P〈0.05）。观察组总有效率93.02%明显高于对照组71.79%,差异有统计学意义（P〈0.01）。两组不良反应比较差异无统计学意义（P〉0.05）。结论莫西沙星治疗老年CAP临床疗效优于三代头孢的罗氏芬。     

左氧氟沙星序贯疗法对社区获得性肺炎治疗效果观察

目的观察左氧氟沙星静脉滴注和口服序贯疗法治疗社区获得性肺炎的疗效。方法 81例社区获得性肺炎病人,先用左氧氟沙星0.2g静脉滴注,症状好转后分成两组,治疗组48例改用口服左氧氟沙星每次0.1g,1日2次,对照组33例继续静滴左氧氟沙星每次0.2g,1日2次,治疗组疗程4～7d,对照组疗程3～6d。结果治疗组和对照组疗效无显著性差异（P〉0.05）。结论左氧氟沙星静脉与口服序贯治疗社区获得性肺炎和左氧氟沙星全程静脉给药一样具有可行性。     

莫西沙星和左氧氟沙星治疗耐药性肺结核的效果及安全性观察

目的：研究对比莫西沙星和左氧氟沙星治疗耐药性肺结核的临床疗效及其安全性。方法选取2011年6月-2014年6月接受药物治疗的肺结核患者82例,所有患者随机分为莫西沙星组（试验组）与左氧氟沙星组（对照组）各41例。对照组患者给予基础药物以及左氧氟沙星治疗,试验组患者给予基础药物以及莫西沙星治疗,比较2组患者的痰菌转阴率、临床治疗效果以及不良反应情况。结果试验组用药12个月后痰菌转阴率为90.24%明显高于对照组的73.17%（P ＜0.01）。试验组治疗总有效率为87.80%明显高于对照组的70.73%（P ＜0.05）。试验组总不良反应率为12.20%明显低于对照组的26.82%,差异均有统计学意义（P ＜0.05）。结论治疗耐药性肺结核时,莫西沙星比左氧氟沙星具有更好的临床疗效。     

左氧氟沙星与加替沙星治疗社区获得性肺炎的成本-效果分析

目的 比较左氧氟沙星与加替沙星治疗社区获得性肺炎的成本-效果，为临床合理用药提供参考。方法 选择社区获得性肺炎97例，分为左氧氟沙星组（左氧组）与加替沙星组（加替组），统一观察疗效、检查和收费项目，分别给予左氧氟沙星和加替沙星治疗7～10d，观察治疗效果并进行成本-效果分析。结果 左氧组总有效率91．1％．不良反应发生率11．1％，平均成本1096元．C／E值=12．0，加替组总有效率93．9％，不良反应发生率8．2％，平均成本1302元，C／E值：14．1，成本-效果分析ΔC／ΔE=80元，两组总有效率比较．差异无统计学意义（P〉0．05）。结论 左氧氟沙星冶疗社区获得性肺炎比加替沙星更具有药物经济学优势，应优先选择。     

莫西沙星与左氧氟沙星治疗尿路感染有效性与安全性Meta分析

目的：对莫西沙星与左氧氟沙星治疗尿路感染的临床效果进行评价,为临床应用提供循证医学证据.方法：以“莫西沙星”、“左氧氟沙星”、“尿路感染”等为主题词或关键词全面查询国内发表文献的数据库,运用RevMan5.1软件对符合条件的结果进行分析.结果：共纳入12篇文献,总样本量1110例,Meta分析结果为有效性、治愈率、不良反应发生率及细菌清除率的合并OR值分别为1.81（P=0.01）、1.67（P=0.002）、0.75（P=0.21）、1.70（P=0.10）.结果提示莫西沙星的疗效优于左氧氟沙星,不良反应发生率及细菌清除率与左氧氟沙星相比差异无统计学意义.针对莫西沙星口服及静脉两种给药方法进行亚组分析,结果提示口服给予莫西沙星治疗尿路感染的有效率及治愈率高于左氧氟沙星,而静脉给予莫西沙星有效率及治愈率与左氧氟沙星相比差异无统计学意义.结论：在尿路感染治疗中,莫西沙星较左氧氟沙星疗效好,安全性好,但由于样本量小、研究质量不高、方法描述不详等,只能为临床研究提供低强度证据.     

Comparison of hospitalization rates in patients with community-acquired pneumonia treated with 10 days of telithromycin or clarithromycin

SUMMARY

Aims: To compare the impact on hospitalization rates and the clinical efficacy of oral telithromycin and clarithromycin treatment in patients with community-acquired pneumonia (CAP).

Patients and methods: Outpatients aged >18 years (n?=?448) with CAP were enrolled in a randomized, double-blind, multinational study and received telithromycin 800?mg once daily (n?=?224) or clarithromycin 500?mg twice daily (n?=?224) for 10 days. The primary outcome measure was clinical efficacy at post-therapy/test of cure (Days 17–24) in the per-protocol population. Frequency of CAP-related hospitalizations, physician visits/tests/procedures, and additional respiratory tract infection-related antibacterial use were compared by treatment group (intent to treat population) up to the late post-therapy visit (Days 31-36). Study investigators who were blinded to the treatment arm assessed whether hospital admissions were CAP related or not. Hospitalization costs (US$) associated with telithromycin and clarithromycin treatment were compared.

Results: Per-protocol clinical cure rates for telithromycin and clarithromycin were statistically equivalent (88.3% [143/162] vs 88.5% [138/156] - difference: ?0.2%; 95% CI: ?7.8, 7.5). There were four CAP-related hospitalizations (1.8 events/100 patients) among patients treated with telithromycin vs eight (3.6 events/100 patients) among clarithromycin patients (p?=?0.281). The total number of CAP-related hospital days for telithromycin and clarithromycin patients was 23 vs 64 days (10.3 vs 28.6 days/100 patients), respectively (p?=?0.177). CAP-related hospitalization costs per 100 telithromycin and clarithromycin patients were $20360 vs $70567, respectively (difference: ?25182; 95% CI: ?49531; 9168).

Conclusions: This study demonstrates that telithromycin is an effective therapy for outpatients with CAP. There were no significant differences in hospitalization rates between treatments; however, a tendency towards a numerically reduced number of hospitalizations/days required in hospital among telithromycin patients was observed. This could potentially translate into reduced hospitalization costs for telithromycin vs clarithromycin in the treatment of CAP.     

痰热清注射液联合左氧氟沙星治疗社区获得性肺炎的Meta及经济学

目的：系统评价痰热清注射液联合左氧氟沙星治疗社区获得性肺炎的有效性、安全性和经济性,为临床合理用药提供循证依据。方法：检索中国知网、万方数据库、维普、PubMed、Cochrane Library、BioMed Central Journals、Embase自建库至2019年2月公开发表的痰热清注射液联合左氧氟沙星与单用左氧氟沙星对社区获得性肺炎患者临床疗效的随机对照试验的文献,运用Revman5.3和State14.0软件进行Meta和药物经济学分析。结果：共纳入17篇文献,2422名患者。Meta分析结果显示,联合使用可以提高社区获得性肺炎患者的治疗有效率,减少退热时间、肺啰音时间、住院时间,用药后其不良反应无明显差异。联合用药与单用的成本-效果分析为ΔC/ΔE=-199.33。结论：联合使用痰热清和左氧氟沙星治疗社区获得性肺炎具有临床效果和经济学的优势,但仍需要通过更多高质量的随机对照试验来验证。