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COMMUNITY ACQUIRED PNEUMONIA

AND DIRECT HOSPITAL COST

 S. Şahbaz1, KC. Tertemiz2, N. Kömüs2, ES.Uçan2, O. Kılınç2, C. Sevinç2

 

 

1Gaziosmanpaşa University, Faculty of Medicine, Chest Disease, Tokat 2Dokuz Eylül University, Faculty of Medicine, Chest Disease, İzmir

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OBJECTIVES

Cases with community aquired pneumonia (CAP)

General characteristics Cost Factors affecting cost

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Materials-Methods

January 2004-December 2005

Hospitalized CAP patients in Dokuz Eylul

University Hospital Pulmonary Medicine

Retrospectively

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CAP

General characteristics Laboratory analysis in 72 hours Requirement for ICU Need for antibiotic change at the 72th hour Accordance of antibiotherapy to Turkish

Thoracic Society CAP Guideline

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Direct Hospital Cost

Laboratory Radiology Medicine Total cost

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RESULTS

114 CAP patients

34 female (29,8%)

80 male (70,2%)

7

0

10

20

30

40

50

60

70

80

Age

total

Group 2

Group 3A

Group 3B

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94 of patients (82,5%) have comorbid diseases

n* %

CNS diseases 29 25,4

Diabetes Mellitus 27 23,7

COPD 26 22,8

Congestive heart failure 17 14,9

Malignity 9 7,9

Immunosuppressive therapy 7 6,1

Destroyed lung 4 3,5

Chronic renal failure 3 2,6

*There are cases more than one comorbidity.

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Symptoms n* % Cough 72 63.2

Fever 71 62.3

Dispnea 59 51.8

Sputum 58 50.9

Bad clinical status 42 36.9

Wheezing 20 17.5

Confusion 14 12.3 *Birden fazla yakınması olan olgu bulunmaktadır.

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Hospitalisation n %

Emergency Service 96 84.2

Polyclinic 16 14.0

Other department 2 1.8

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Infiltration Localisation in Chest X-ray

n %Right

upper

middle

lower

12 10.5

22 19.3

45 39.5

Left

upper

middle

lower

1 0.9

11 9.6

23 20.2

*21 of patients (18.4%) have pleural effusion.

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Microbiological analysis;

64 (56,1%) Microorganisms detected in;

11 (17,1%)

13

0

5

10

15

20

25

30

35

40

45

50

Blood Sputum Trachealaspiration

Br lavage Pleuralfluid

Number

Grown

14

Sputum n H.influenza 2 K.pneumonia 3 Enterobactericea 2

Blood K.pneumonia 1 E. coli 1

Bronchial lavage

P.flurences 1

Tracheal aspiration

P.aeroginosa 1

TOTAL 11

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Antibiotherapy were changed in 9 patients

because of no fever response at 72th hour

ICU need in 6 patients, mean ICU stay 6,6 (1-

18) days.

Mortality rate: 2,6% (3 patients in Group 3B)

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Groups According to Turkish Thoracic Society CAP Guideline

0

10

20

30

40

50

60

70

80

Group 2 Group 3A Group 3B

Group 2Group 3AGroup 3B

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Length of Stay According to Groups

0

2

4

6

8

10

12

2 3A 3B total

23A3Btotal

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Initial therapy is appropriate to

Turkish Thoracic Society CAP Guideline

in 76 patients (%69.3)

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Appropriate to CAP Guideline

Lenght of Stay

(day) p Yes (n=79) 11.0

0.872 No (n=35) 10.8

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Mean Cost of CAP

Radiology…………….. 80,54 $ (65.38 €)

Laboratory……………405.73 $ (329.38 €)

Medicine.. ……………596.91 $ (484.59 €)

Total….. ……........... 2008.74 $ (1630.77 €)

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p2 3A 3B

$ € $ € $ €

Radiology 52.35 42.50 93.68 76.05 84.06 68.24 0.405

Laboratory 318.66 258.70 492.52 399.84 410.76 333.47 0.530

Medicine 304.67 251.64 460.11 373.54 667.95 542.27 0.034

Total 1017.74 826.24 1533.15 1244.66 2251.13 1827.55 0.020

COST

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Accordance of antibiotherapyto CAP Guideline

Yes(n=79)

No (n=35) p

$ € $ €

Laboratory 373.13 302.92 479.28 389.09 0.087

Radiology 77.28 62.74 87.90 71.36 0.423

Medicine 543.54 441.26 717.38 582.39 0.311

Total 1827.08 1483.29 2418.78 1963.65 0.311

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Total Costp

$ €

Gender Female (n=34)

Male (n=80)

2022.27

2002.99

1641.75

1626.10

0.965

Age ≥65 years (n=85)

<65 years (n=29)

1897.48

2334.85

1540.45

1895.51

0.469

Comorbid diseases Yes (n=94)

No (n=20)

2164.18

1278.16

1756.96

1037.66

0.003

Accordance of initial therapy to CAP Guideline Yes (n=79)

No (n=35)

1827.08

2418.78

1483.29

1963.65

0.311

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Discussion

In USA, 60.000 cases are hospitalised

each year and total cost is 23 milyar $/year1 No data in our country

1Gregory PS, David BM, James H, Jerome W. A.Cost minimization analysis compairing azithromycin based and levofloksasin based protocols for the treatment of patients hospitalized with community acquired pneumonia. Chest 2005; 128:3246-54

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Mean cost in our research is 2656.37 YTL Costs in other researches

1333 $ (127-9488) $ 2

1553±542 € 8

2Baurer TT, Welte T, Emen C, Schlosser BM, Thate-Waschke I, de Zeeuw J, Schultze- Werninghause GCost analyses of community-acquired pneumonia from the hospital perspective. Chest. 2005 Oct;128(4):2238-46 8A population-based study of the costs of care for community-acquired pneumonia. M. Bartolome M, J. Almirall, J. Morera, G. Pera, V. Ortún, J. Bassa, I. Bolíbar, X. Balanzó, A. Verdaguer the Maresme Community-Acquired Pneumonia Study Group (GEMPAC)Eur Respir J. 2004 Apr;23(4):610-6

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Monotherapy and long half life drugs

Antibiotics must be changed to oral rapidly

3Lutfiyya MN, Henley E, Chang LF, Reyburn SW. Diagnosis and treatment of community-acquired pneumonia. Am Fam Physician. 2006 Feb 1;73(3):442-50

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We couldn’t analyse antibiotic changing time to oral.

We found that most important factor increasing the cost is the medicine cost.

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In most patients empirical therapy is started according to mostly seen microorganisms and patients status empiricaly3.

In our research low ICU need, antibiotic change at 72th hour and mortality rate was determined with empirical therapy.

3Lutfiyya MN, Henley E, Chang LF, Reyburn SW. Diagnosis and treatment of community-acquired pneumonia. Am Fam Physician. 2006 Feb 1;73(3):442-50

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Researches analysing guideline accordance are mostly retrospective.

It is shown that guideline accordance decreases hospitalisation time and total cost in a prospective research.

4Brown PD. Adherence to guidelines for community-acquired pneumonia: does it decrease cost of care? Pharmacoeconomics. 2004;22(7):413-20

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Gleason et al analysed guideline accordance (ATS 1993) and effects on hospitalisation and total cost firstly

≤60 years, no comorbid disorders and appropriate

therapy to guideline decreases the cost5.

5Gleason PP, Kappor WN, Stone RA, Lave JR, Obrosky DS, Schulz R, Singer DE, Coley CM, Marrie TJ, Fine MJ. Medical outcomes and antimicrobial costs with the use of the American Thoracic Society guidelines for outpatients with community-acquired pneumonia. JAMA. 1997 Jul 2;278(1):32-9

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In a multicentric, retrospective research; longer lenght of stay

and high mortality is determined in patients with

inappropriate therapy to guideline 6

Patients with appropriate therapy to ATS and IDSA (The

Infectious Diseases Society of America) have short

hospitalisation time, and lower cost and mortality 4,7

4Brown PD. Adherence to guidelines for community-acquired pneumonia: does it decrease cost of carePharmacoeconomics. 2004;22(7):413-20 6Malone DC, Shaban HM. Ann Pharmacother. 2001;35: 1180-85 Adherence to ATS guidelines for hospitalized patients with community-acquired pneumonia.7Battleman DS, Callahan M, thaler HT. Rapid antibiotic delivery and appropriate antibiotic selection reduce length of hospital stay of patients with community-acquired pneumonia: link between quality of care and resource utilization. Arch Intern Med. 2002;162: 682-8

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We found no correlation between appropriate therapy to guideline and lenght of stay and cost

There are few researches showing about 4% mortality in CAP8. We have 3(2,6%) exitus, so we didn’t analyse these patients in detail.

8A population-based study of the costs of care for community-acquired pneumonia. M. Bartolome M, J. Almirall, J. Morera, G. Pera, V. Ortún, J. Bassa, I. Bolíbar, X. Balanzó, A. Verdaguer the Maresme Community-Acquired Pneumonia Study Group (GEMPAC)Eur Respir J. 2004 Apr;23(4):610-6

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In our research No correlation with elder age and cost Patients with comorbid disorders have higher cost

ICU requirement is the other factor that increases the cost. We didn’t analyse these patients because of low number.

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SUMMARY

Patients with comorbid diseases and group 3B have higher cost

No correlation between cost and appropriate therapy to guideline, elder age, and gender

Most important factor increasing the cost is medicine cost.