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Enferm Infecc Microbiol Clin. 2000 Nov;18(9):445-51.
[Analysis of the cost-effectiveness relationship in the empirical treatment in patients with infections of the lower respiratory tract acquired in the community]

[Article in Spanish]

Bertran MJ, Trilla A, Codina C, Carne X, Ribas J, Asenjo MA.

Epidemiologia Hospitalaria-Centro de Epidemiologia, Evaluacion, Soporte y Prevencion (CEASP).

BACKGROUND: Cost of treatment of community-acquired infections in Spain is an important factor in overall health expenditures. The aim of this study was to assess the direct health costs related with the treatment of patients with community-acquired pneumonia (CAP) and acute exacerbations of chronic bronchitis (AECB) due to infection, using different antibiotic options, and to identify main cost drivers. METHODS: A basic decision analysis model was developed, including probabilities estimation derived from the literature review, supplemented when needed by the opinion of a panel of 8 Spanish physicians (Delphi technique). Four groups of antibiotics were included (macrolides, beta-lactam, fluoroquinolones and cephalosporins) in two different groups: patients with CAP without hospital admission criteria and patients with AECB due to respiratory infection. The analytic horizon and the perspective used were those of the Spanish National Health Service. Direct cost were assessed (drugs, outpatient visits, hospital admissions, diagnostic tests). Indirect cost were not included in the model. Final costs uses as main outcome measure the average cost per patient treated. All results were calculated following a fold-back technique. Sensitivity analysis were included allowing for variations in several clinically relevant parameters. RESULTS: 1. Patients with CAP: Hospital admissions, directly related to the effectiveness rate of initial empirical antibiotic therapy, were the main cost driver (50%-70%). Acquisition costs of initial antibiotic therapy only account for 2%-13% of total costs. 2. Patients with AECB: Outpatient visits are the main cost driver for these group of patients (49% of total costs). Hospital admission costs are also an important cost driver (40%-51% of total costs). Acquisition costs of initial antibiotic therapy account for 4%-28% of total costs. Clinical effectiveness of first antibiotic option is the main variable regarding the cost-effectiveness rate. CONCLUSION: The model here presented showed that acquisition costs of first empirical antibiotic therapy are only a small proportion of total costs related with the management of community acquired lower respiratory tract infections in Spain. The clinical effectiveness rate of the first antibiotic used is the main variable which determines the final average cost per patient cured. For patients with lower respiratory tract infections the therapeutic option with a better cost-effectiveness ratio must be chosen, in order to minimize the risk of therapeutic failure after first line therapy, and should not be selected only by its lower acquisition costs.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11149168&dopt=Abstract

Presse Med. 2000 Dec 2;29(37):2042-3.
[Telithromycin, a once-a-day ketolide in the treatment of community acquired pneumonia]

[Article in French]

Carbon C.

Hopital Bichat, Paris.

KETOLIDES: The principal advantage of this series of original compounds elaborated from macrolides is their activity against pneumococci and against macrolide-resistant streptococci while preserving the remainder of the macrolide spectrum of activity, particularly for intracellular germs. TELITHROMYCIN: To date, the main indications have been assessed in adults: pneumonia, super-infection of chronic bronchitis, sinusitis and pharyngitis. The recommended dose is 800 mg once a day. The safety of this dose has been validated for patients treated for 7 to 10 days for community-acquired pneumonia. CONTRIBUTION TO CURRENT STRATEGIES: Should telithromycin be proposed as first line treatment for community-acquired respiratory tract infections or should it be used as an alternative treatment for situations where no other antibiotic can be used?

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11155730&dopt=Abstract

Respir Med. 2003 Mar;97 Suppl C:S33-42.
The burden of COPD in France: results from the Confronting COPD survey.

Piperno D, Huchon G, Pribil C, Boucot I, Similowski T.

Centre Medical Parot, Lyon, France. dpipernnfonie.fr

Chronic obstructive pulmonary disease (COPD) is an obstructive lung disorder characterized by progressive airflow limitation that is not reversible or only partially reversible, including chronic bronchitis and emphysema. Confronting COPD in North America and Europe was the first large-scale international survey to attempt to quantify the country-specific burden of the disease, collecting data on clinical outcomes, healthcare resource utilization, and lost productivity, from patients and physicians in France and seven other countries.The economic analysis of the French survey results showed that patients with COPD required considerable utilization of healthcare resources, with annual direct costs estimated at Euro 530 per patient In addition, COPD-related illness or disability prevented many patients from working, with an estimated annual indirect cost of Euro 1078 per patient The survey suggested underdiagnosis and undertreatment of COPD by healthcare professionals, and patients reported poor symptom control. The cost of unscheduled care (Euro 151) was almost double the cost of scheduled visits to healthcare professionals (Euro 82). This suggests that improving the long-term management of chronic symptoms by healthcare professionals could reduce the burden of disease. As in other countries, the clinical management of COPD in France may be improved by following guideline recommendations for COPD treatment. These include smoking cessation at all stages of the disease, regular treatment of chronic symptoms with bronchodilators in dyspnoeic patients, and pulmonary rehabilitation. The results of the survey also showed that the societal cost of COPD was considerably greater in patients with severe disease (Euro 2882) compared with mild COPD (Euro 289). This suggests that interventions that could help delay the progression of COPD to the advanced stages of the disease (such as smoking cessation) could be of economic benefit.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12647941&dopt=Abstract

J Exp Med. 2001 Feb 5;193(3):339-51.
Interleukin 12 p40 production by barrier epithelial cells during airway inflammation.

Walter MJ, Kajiwara N, Karanja P, Castro M, Holtzman MJ.

Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA.

Human airway epithelial cells appear specially programmed for expression of immune response genes implicated in immunity and inflammation. To better determine how this epithelial system operates in vivo, we analyzed its behavior in mouse models that allow for in vitro versus in vivo comparison and genetic modification. Initial comparisons indicated that tumor necrosis factor alpha induction of epithelial intercellular adhesion molecule 1 required sequential induction of interleukin (IL)-12 (p70) and interferon gamma, and unexpectedly localized IL-12 production to airway epithelial cells. Epithelial IL-12 was also inducible during paramyxoviral bronchitis, but in this case, initial IL-12 p70 expression was followed by 75-fold greater expression of IL-12 p40 (as monomer and homodimer). Induction of IL-12 p40 was even further increased in IL-12 p35-deficient mice, and in this case, was associated with increased mortality and epithelial macrophage accumulation. The results placed epithelial cell overgeneration of IL-12 p40 as a key intermediate for virus-inducible inflammation and a candidate for epithelial immune response genes that are abnormally programmed in inflammatory disease. This possibility was further supported when we observed IL-12 p40 overexpression selectively in airway epithelial cells in subjects with asthma and concomitant increases in airway levels of IL-12 p40 (as homodimer) and airway macrophages. Taken together, these results suggest a novel role for epithelial-derived IL-12 p40 in modifying the level of airway inflammation during mucosal defense and disease.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11157054&dopt=Abstract

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