Pharmacoeconomics of the management of acute exacerbations of chronic obstructive pulmonary disease

Simoens, Steven; Decramer, Marc

doi:10.1517/14656566.8.5.633

Cited by 18 publications

(9 citation statements)

References 50 publications

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“…The likelihood of reductions in both costs and exacerbations is greater for older patients, although the cost per avoided severe exacerbation may still be high. Yet when one considers unmeasured consequences of repeated exacerbations (i.e., decreased quality of life, productivity loss, or caregiver time), the additional expenses may be compensated by additional benefits (D'Souza et al 2006; Simoens and Decramer 2007).…”

Section: Discussionmentioning

confidence: 99%

Assessing Treatment Effects of Inhaled Corticosteroids on Medical Expenses and Exacerbations among COPD Patients: Longitudinal Analysis of Managed Care Claims

Akazawa

Stearns

Biddle

2008

Health Services Research

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Objective. To assess costs, effectiveness, and cost‐effectiveness of inhaled corticosteroids (ICS) augmenting bronchodilator treatment for chronic obstructive pulmonary disease (COPD). Data Sources. Claims between 1997 and 2005 from a large managed care database. Study Design. Individual‐level, fixed‐effects regression models estimated the effects of initiating ICS on medical expenses and likelihood of severe exacerbation. Bootstrapping provided estimates of the incremental cost per severe exacerbation avoided. Data Extraction Methods. COPD patients aged 40 or older with ≥15 months of continuous eligibility were identified. Monthly observations for 1 year before and up to 2 years following initiation of bronchodilators were constructed. Principal Findings. ICS treatment reduced monthly risk of severe exacerbation by 25 percent. Total costs with ICS increased for 16 months, but declined thereafter. ICS use was cost saving 46 percent of the time, with an incremental cost‐effectiveness ratio of $2,973 per exacerbation avoided; for patients ≥50 years old, ICS was cost saving 57 percent of time. Conclusions. ICS treatment reduces exacerbations, with an increase in total costs initially for the full sample. Compared with younger patients with COPD, patients aged 50 or older have reduced costs and improved outcomes. The estimated cost per severe exacerbation avoided, however, may be high for either group because of uncertainty as reflected by the large standard errors of the parameter estimates.

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Section: Discussionmentioning

confidence: 99%

Assessing Treatment Effects of Inhaled Corticosteroids on Medical Expenses and Exacerbations among COPD Patients: Longitudinal Analysis of Managed Care Claims

Akazawa

Stearns

Biddle

2008

Health Services Research

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“…In the last decade, multidimensional scores have been introduced in order to better assess COPD outcomes, particularly the mortality risk, even if results were variable due to their different specificity and sensitivity [3,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23]. The vast majority of studies have stated that exacerbations represent the main driver of COPD burden because they can affect morbidity, quality of life, hospitalizations, mortality, and related healthcare expenditure [24,25,26,27,28].…”

Section: Cost Trends In Real Lifementioning

confidence: 99%

COPD: The Annual Cost-Of-Illness during the Last Two Decades in Italy, and Its Mortality Predictivity Power

Negro

2019

Healthcare

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Chronic obstructive pulmonary disease (COPD) is a progressive pathological condition characterized by a huge epidemiological and socioeconomic impact worldwide. In Italy, the actual annual cost of COPD was assessed for the first time in 2002: the mean cost per patient per year was €1801 and ranged from €1500 to €3912, depending on COPD severity. In 2008, the mean annual cost per patient was €2723.7, ranging from €1830.6 in mild COPD up to €5451.7 in severe COPD. In 2015, it was €3291, which is 20.8% and 82.7% higher compared to the costs estimated in 2008 and 2002, respectively. In all these studies, the major cost component was direct costs, in particular hospitalization costs due to exacerbations, which corresponded to 59.9% of the total cost and 67.2% of direct costs, respectively. When the annual healthcare expenditure per patient is related to the length of survival by means of the PRO-BODE Index (PBI, which is the implementation of the well-known BODE Index with costs due to annual exacerbations and/or hospitalizations), the annual cost of care proved much more strictly and inversely proportional to patients’ survival at three years, with the highest regression coefficient (r = −0.58) of all the multidimensional indices presently available, including the BODE Index (r = −021). In Italy, even though tobacco smoking has progressively declined by up to 21% in the general population, the economic impact of COPD has shown relentless progression over the last two decades, confirming that the present national health system organization is still insufficient for facing the issue of chronic diseases, in particular COPD, effectively. The periodic assessment of costs is an effective instrument for care providers in predicting COPD mortality, and for decision makers for updating and planning their social, economic, and political strategies.

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“…The authors compared comparative costs and the comparative effectiveness of first-generation antibiotics (aminopenicillins, macrolides and tetracyclines) and second-generation antibiotics (eg, fluoroquinolones). Fluoroquinolones generally had higher acquisition costs than first-generation antibiotics, but both macrolides and fluoroquinolones were equally effective 12 13. In total, 38.8% of antibiotics were more effective and less costly than the comparator; 45.9% of antibiotics improved effectiveness but also increased costs; 15.3% of antibiotics were less effective and more costly than the comparator.…”

Section: Discussionmentioning

confidence: 98%

“…A study by Simoens and Decramer12 revealed that the cost of antimicrobials in an institution, especially in the intensive care unit, represents 30–50% of total drug costs and at least 50% of patients make use of antibiotics on hospitalisation. Hospitalisation costs accounted for more than 45% of healthcare costs and drug costs made up between 6% and 21% of costs.…”

Section: Discussionmentioning

confidence: 99%

Indigenous rapid diagnostic technology for antibiotic susceptibility testing in urinary tract infection: from bench side to bedside

Kapila

Gupta²

2017

BMJ Innov

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Infectious diseases are a significant burden on global economies and public health. There are indeed more deaths due to infections than cancer demonstrating that it is high time to pay attention to the escalating bacterial enemy. Urinary tract infections (UTIs) pose a serious health problem affecting millions of people each year with total cost for treatment being in billions of dollars. A large share of that expense and inappropriate use of antimicrobials comes from a 48 hours wait for the infected sample to be cultured in the laboratory and tested for antibiotic sensitivity (AST). The current study presents an ultra-rapid point-of-care system for determining AST of pathogens found in human urine leading to UTI. Sensitivity and specificity of the new test for antibiotic susceptibility was found to be 0.94 and 0.97, respectively. The results of AST using the new test are available in 4 hours as compared with 48-72 hours of conventional methods. Availability of this rapid assay will obliterate the need for empirical treatment in case of UTI-like infectious diseases and lead to specific and most appropriate treatment at the earliest ensuring healthcare to all. Further as the result of cultures are available in ∼4 hours this test facilitates de-escalation necessary for the containment of bacterial resistance, favours targeted patient therapy with reduced antimicrobial spectrum of action of prescribed antibiotics and, consequently, lowers the cost of treatment significantly. BACKGROUNDInfectious diseases are a significant burden on global economies and a major public health threat. The fight against bacterial infection represents one of the highest challenges of modern medicine.

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Pharmacoeconomics of the management of acute exacerbations of chronic obstructive pulmonary disease

Cited by 18 publications

References 50 publications

Assessing Treatment Effects of Inhaled Corticosteroids on Medical Expenses and Exacerbations among COPD Patients: Longitudinal Analysis of Managed Care Claims

Assessing Treatment Effects of Inhaled Corticosteroids on Medical Expenses and Exacerbations among COPD Patients: Longitudinal Analysis of Managed Care Claims

COPD: The Annual Cost-Of-Illness during the Last Two Decades in Italy, and Its Mortality Predictivity Power

Indigenous rapid diagnostic technology for antibiotic susceptibility testing in urinary tract infection: from bench side to bedside

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