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Free Content Cost and clinical consequence of antibiotic non-adherence in acute exacerbations of chronic bronchitis [Review article]

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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.

Keywords: acute exacerbations of chronic bronchitis; adherence; 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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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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