Cost and clinical consequence of antibiotic non-adherence in acute exacerbations of chronic bronchitis [Review article]
Abstract:OBJECTIVE: To quantify the impact of non-adherence on the clinical effectiveness of antibiotics for acute exacerbations of chronic bronchitis (AECB) and to estimate the economic consequences for Spain, Italy and the United States.
METHODS: Standard systematic reviewing procedures were followed to identify randomised controlled clinical trials of antibiotic treatment for acute respiratory tract infection for which adherence was reported. A decision-analytic model was then constructed to evaluate the impact of non-adherence to antibiotic treatment on clinical effectiveness and costs per AECB episode. The model compared the total treatment costs, cure rates and incremental costs per cure for a poor compliance group (PCG) against a good compliance group (GCG). Clinical and resource use estimates were from the published literature and physician surveys.
RESULTS: Twenty-five articles met the criteria of the systematic review, although only one reported treatment success by adherence status. The relative risk of clinical effectiveness if non-adherent was 0.75 (95%CI 0.73–0.78). Based on this single study, the model predicted that 16–29% more patients would be cured in the GCG vs. the PCG, and payers would save up to €122, €179 and US$141 per AECB episode in Spain, Italy and the United States, respectively.
CONCLUSIONS: Non-adherence to antibiotics for AECB may have an impact on clinical effectiveness, which is associated with increased costs.
Document Type: Review Article
Affiliations: 1: United BioSource Corporation, Bethesda, Maryland, USA 2: Pfizer Inc, New York, New York, USA 3: Centre for Economics & Policy in Health, Bangor University, Dean Street, Bangor, Wales, UK
Publication date: August 1, 2009
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