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Variations in antimicrobial use and cost in more than 2,000 patients with community-acquired pneumonia
K Gilbert1, P P Gleason, D E Singer
1Department of Medicine, St. Joseph's Health Center and Faculty of Medicine, University of Western Ontario, London, Canada.
Purpose:
To assess the patterns of antimicrobial use, costs of antimicrobial therapy, and medical outcomes by institution in patients with community-acquired pneumonia.
Patients And Methods:
The route, dose, and frequency of administration of all antimicrobial agents prescribed within 30 days of presentation were recorded for 927 outpatients and 1328 inpatients enrolled in the Pneumonia Patient Outcomes Research Team (PORT) multicenter, prospective cohort study. Total antimicrobial costs were estimated by summing drug costs, using average wholesale price for oral agents and institutional acquisition prices for parenteral agents, plus the costs associated with preparation and administration of parenteral therapy. Thirty-day outcome measures were mortality, subsequent hospitalization for outpatients, and hospital readmission for inpatients.
Results:
Significant variation (P <0.05) in prescribing practices occurred for 17 of the 23 antimicrobial agents used in outpatients across 5 treatment sites, and for 18 of the 20 parenteral agents used in inpatients across 4 treatment sites. The median duration of antimicrobial therapy for treatment site ranged from 11 to 13 days for outpatients (P=0.01), and from 13 to 15 days for inpatients (P=0.49). The overall median cost of antimicrobial therapy was $12.90 for outpatients, and ranged from $10.80 to $58.90 among treatment sites (P <0.0001). The overall median cost of antimicrobial therapy was $228.70 for inpatients, and ranged from $183.70 to $315.60 among sites (P <0.0001). Mortality and hospital readmission for inpatients were not significantly different across sites after adjusting for baseline differences in patient demographic characteristics, comorbidity, and illness severity. Although subsequent hospitalization for outpatients differed by site, the rate was lowest for the site with the lowest antimicrobial costs.
Conclusion:
Variations in antimicrobial prescribing practices by treatment site exist for outpatients and inpatients with community-acquired pneumonia. Although variation in antimicrobial prescribing practices across institutions results in significant differences in antimicrobial costs, patients treated at institutions with the lowest antimicrobial costs do not demonstrate worse medical outcomes.
Insights
Antimicrobial prescribing for community-acquired pneumonia varies significantly by institution. Lower antimicrobial costs are not associated with worse patient outcomes, suggesting opportunities for cost savings in pneumonia treatment.
Area of Science:
- Infectious Diseases
- Health Services Research
- Pharmacoeconomics
Background:
- Community-acquired pneumonia (CAP) treatment involves significant antimicrobial use and associated costs.
- Understanding institutional variations in prescribing practices is crucial for optimizing CAP management.
- Previous studies have highlighted variability in healthcare practices, but specific data on antimicrobial use and costs in CAP are needed.
Purpose of the Study:
- To analyze antimicrobial prescribing patterns, therapy costs, and patient outcomes across different institutions for community-acquired pneumonia.
- To identify variations in antimicrobial use and expenditure among treatment sites.
- To correlate antimicrobial costs with patient outcomes in CAP.
Main Methods:
- A multicenter, prospective cohort study (Pneumonia Patient Outcomes Research Team - PORT) involving 927 outpatients and 1328 inpatients.
- Detailed recording of antimicrobial agents, including route, dose, and frequency, within 30 days of presentation.
- Estimation of total antimicrobial costs using average wholesale prices and institutional acquisition prices, including preparation and administration costs.
Main Results:
- Significant institutional variations observed in prescribing practices for both outpatient and inpatient CAP treatment.
- Median duration of antimicrobial therapy varied across sites for outpatients (11-13 days) but not significantly for inpatients (13-15 days).
- Substantial cost differences were found: median outpatient costs ranged from $10.80 to $58.90, and inpatient costs ranged from $183.70 to $315.60.
- No significant differences in mortality or readmission rates for inpatients across sites after adjusting for patient factors.
- Outpatient subsequent hospitalization rates differed by site, with the lowest rate observed at the site with the lowest antimicrobial costs.
Conclusions:
- Significant variations in antimicrobial prescribing practices for CAP exist among healthcare institutions.
- These prescribing variations lead to considerable differences in antimicrobial therapy costs.
- Patients receiving care at institutions with lower antimicrobial costs did not experience worse medical outcomes, indicating potential for cost-effective treatment strategies.