Palmer C, Zhan C, Halpern M, Elixhauser A, Rance L, Zarnke K, Feagen B, Marrie T; Interscience Conference on Antimicrobial Agents and Chemotherapy.

Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 1999 Sep 26-29; 39: 742 (abstract no. 1863).

MEDTAP Intl., Bethesda, MD

BACKGROUND: Community-acquired pneumonia (CAP) is a common and potentially fatal condition for which treatment patterns vary widely.METHODS: Economic outcomes were assessed in a cluster-design randomized controlled trial that evaluated use of a critical pathway designed to manage CAP more efficiently than usual care. The critical pathway included: a clinical prediction rule to guide the admission decision; treatment with levofloxacin as the primary antibiotic; and practice guidelines. Participating Canadian hospitals were randomized to implement the critical pathway (n = 9) or usual care (n = 10). Data were collected prospectively for a minimum of 6 weeks following treatment on medical resource use, lost productivity, and quality of life, measured with the MOS SF-36. Costs were assigned using standard national sources and were calculated from government, hospital, and societal perspectives. A mixed effect model was used to impute missing outpatient and lost productivity costs. Bootstrapping identified 95% confidence intervals for the total cost for each of the three study perspectives.RESULTS: Analysis included all eligible patients in the usual care (n = 1,027) and critical pathway (n = 716) arms. Compared with usual care, hospitals in the critical pathway arm had 1.7 fewer bed days per patient managed (p = 0.045), and used fewer inpatient medical resources, resulting in lower costs. The two study arms had similar outpatient costs (range: 3%-6% of total cost), readmission and lost productivity costs, and quality of life outcomes [table: see text].CONCLUSION: For each study perspective, the critical pathway using levofloxacin was cost-saving compared with usual care. Use of the critical pathway did not compromise health outcomes.

Publication Types:

• Meeting Abstracts

Keywords:

• Anti-Bacterial Agents
• Biomedical Research
• Canada
• Cluster Analysis
• Costs and Cost Analysis
• Critical Pathways
• Humans
• Ofloxacin
• Outcome Assessment (Health Care)
• Pneumonia
• Practice Guidelines as Topic
• Research Design
• economics
• methods

Other ID:

• GWAIDS0009022

UI: 102246519

From Meeting Abstracts