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COMMUNITY ACQUIRED PNEUMONIA AND DIRECT HOSPITAL COST

COMMUNITY ACQUIRED PNEUMONIA AND DIRECT HOSPITAL COST. S. Şahbaz 1 , KC. Tertemiz 2 , N. Kömüs 2 , ES.Uçan 2 , O. Kılınç 2, C. Sevinç 2 1 Gaziosmanpaşa University, Faculty of Medicine, Chest Disease, Tokat 2 Dokuz Eyl ü l University, Faculty of Medicine, Chest Disease, İzmir. OBJECTIVES.

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COMMUNITY ACQUIRED PNEUMONIA AND DIRECT HOSPITAL COST

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  1. COMMUNITY ACQUIRED PNEUMONIA AND DIRECT HOSPITAL COST S. Şahbaz1, KC. Tertemiz2, N. Kömüs2, ES.Uçan2, O. Kılınç2, C. Sevinç21Gaziosmanpaşa University, Faculty of Medicine, Chest Disease, Tokat2Dokuz Eylül University, Faculty of Medicine, Chest Disease, İzmir

  2. OBJECTIVES • Cases with community aquired pneumonia (CAP) • General characteristics • Cost • Factors affecting cost

  3. Materials-Methods • January 2004-December 2005 • Hospitalized CAP patients in Dokuz Eylul University Hospital Pulmonary Medicine • Retrospectively

  4. 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

  5. Direct Hospital Cost • Laboratory • Radiology • Medicine • Total cost

  6. RESULTS 114 CAP patients 34 female (29,8%) 80 male (70,2%)

  7. 94 of patients (82,5%) have comorbid diseases *There are cases more than one comorbidity.

  8. *Birden fazla yakınması olan olgu bulunmaktadır.

  9. Infiltration Localisation in Chest X-ray *21 of patients (18.4%) have pleural effusion.

  10. Microbiological analysis; 64 (56,1%) • Microorganisms detected in; 11 (17,1%)

  11. 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)

  12. Groups According to Turkish Thoracic Society CAP Guideline

  13. Length of Stay According to Groups

  14. Initial therapy is appropriate to Turkish Thoracic Society CAP Guideline in 76 patients (%69.3)

  15. Mean Cost of CAP • Radiology…………….. 80,54 $ (65.38 €) • Laboratory……………405.73 $ (329.38 €) • Medicine..……………596.91 $ (484.59 €) • Total….. ……........... 2008.74 $ (1630.77 €)

  16. COST

  17. 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

  18. 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 G Cost 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

  19. 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

  20. We couldn’t analyse antibiotic changing time to oral. • We found that most important factor increasing the cost is the medicine cost.

  21. 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

  22. 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

  23. 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

  24. 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 care Pharmacoeconomics. 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

  25. 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

  26. 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.

  27. 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.

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