Abstract
Background
Exacerbations are a major cause of disability, hospital admissions, and increased healthcare costs in patients with chronic obstructive pulmonary disease (COPD). This study investigated the clinical outcomes of outpatients with moderate to severe exacerbated COPD and their related costs.
Methods
An observational study on the outcomes of ambulatory exacerbations of COPD was conducted. The course of the exacerbation was evaluated at a follow-up visit at 4 weeks. A cost analysis that encompassed the use of healthcare resources for treatment of the exacerbation was performed.
Results
A total of 260 patients were included, with a mean age of 68.3 years and a mean FEV1 (% predicted) of 58.9 %. Twenty-two percent of patients had significant cardiovascular comorbidity. The most frequently prescribed antibiotics were moxifloxacin in 137 cases and amoxicillin–clavulanate in 50 cases. The rate of failure at 4 weeks was 12.5 %, with no differences between the two most prescribed antibiotics; however, patients treated with moxifloxacin had symptoms for 1.9 fewer days (P = 0.01). The mean cost of the exacerbation was €344.96 (95 % CI: €48.55–€641.78), with 9.6 % of the costs for drugs and 72.9 % for hospital care of patients for whom treatment had failed.
Conclusions
Antibiotic treatment of our population was in compliance with local guidelines. The rate of failure observed in our study was lower than that reported in previous studies; however, the small percentage of patients that required hospital attention generated almost two-thirds of the total costs of the exacerbations.
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Acknowledgments
This study was funded by an unrestricted Grant from Bayer Healthcare Spain. The authors thank Rosa Palomino (GOC Networking, Barcelona, Spain) for her support in data management and statistical analysis. The following investigators participated in the field work of the study: Eva Aguarón Joven, CS Perpetuo Socorro—Huesca, Ramon AgüeroBalbín, HU Marqués de Valdecilla—Santander, Juan Carlos Aguirre Rodriguez, CS Casería de Montijo—Granada, Jose Alcaraz Ramirez, Hospital Quirón—Málaga, Pilar Arizón Deza, CS Rebolería—Zaragoza, Juan Barón Carrillo, CS Las Marinas—Almería, Salvador Bello Dronda, HU Miguel Servet—Zaragoza, María Teresa Benedí Sánchez, UBS Puerto de Alcudia—Islas Baleares, José Miguel Benedicto Lorenzo, CS Rebolería—Zaragoza, Luis Borderías Clau, Hospital San Jorge—Huesca, Juan Carmona Carmona, CS Virgen del Rosario—Málaga, Ignacio Casado Moreno, HU Virgen de las Nieves—Granada, Jose María Castillo, CS Pirineos—Huesca, Antonio Castillón Fantova, CS Pirineos—Huesca, Mª Lourdes Clemente Jiménez, CS Santo Grial—Huesca, Rodrigo Córdoba García, CS Delicias Sur—Zaragoza, Julián Correa de la Calle, CS La Laguna—Cádiz, Luis María Entrenas Costa, Hospital Reina Sofía—Córdoba, Araceli Fernandez Revuelta, CS Delicias Sur—Zaragoza, José Antonio Fernández Rodríguez, CS Camargo—Santander, José Luis Flores Velasco, CS Chana—Granada, Carmen Galvez Beaterio, CS Virgen del Valle—Sevilla, Enrique Garcia Fraile—Málaga, Angel GarcíaLuján, CS Velutti—Granada, Francisco BorjaGarcía-CosíoPiqueras, Hospital Son Dureta—Islas Baleares, Carmen García-Gutiérrez Muñoz, CS Rebolería—Zaragoza, Leovigildo Ginel Mendoza, CS Ciudad Jardín—Málaga, Francisco Alberto González Jiménez, CS Dos Hermanas—Sevilla, Lucía Gorreto López, UBS Puerto de Alcudia—Islas Baleares, Rafael Guerrero Zamorano, CS Nueva Málaga—Málaga, Luis Gutierrez Bardeci, CS Puertochico—Santander, Juan A. Gutiérrez Espinosa, CS San Fernando Este—Cádiz, Matías Gutiérrez Fernandez, CS Ntra. Sra. De las Nieves—Sevilla, Maria Teresa Lamban Sanchez, CS Reboleria—Zaragoza, José Luis López Campos, Hospital Virgen del Rocío—Sevilla, PalomaLoscertales, CS Rebolería—Zaragoza, Ana Manzano Molina, CS Alcazaba—Almería, Manuel Morales Abad, CS Joaquin Pece—Cádiz, Juana Carmen Morales Naranjo, CS Ciudad Jardín—Málaga, Nicolas Najem Rizk, CS Caleta—Granada, Manuel Palomino Palma, CS Nerja—Málaga, Jose Rabasco Prieto, Sector Sur—Córdoba, Mercedes Remónn Rodriguez, CS La Paz—Cádiz, Jose Luis Rojas Box, H. Mar Écija—Sevilla, Manuel Romero Martin, CS Virgen del Valle—Sevilla, Romualdo Roncero Romero, CS Rodriguez Arias—Cádiz, Javier Rubio Lopez, CS Almería Centro—Almería, Fernando Salas Herrera, CS Castilla—Hermida—Santander, J. Jesus Sanchez-Pardo Garcia, CS La Paz—Cádiz, Jose Miguel Solís de Dios, CS Mairena del Aljarafe—Sevilla, Francisco Taboada Gonzalez, CS Ciudad Jardín—Málaga, Jesus Manuel Ubalde Sainz, CS Rebolería—Zaragoza, Nuria Val Jimenez, CS Perpetuo Socorro—Huesca, Alfredo Vidal Montero, CS Fuensanta—Córdoba, Victoria Viota González, CS Cazoña—Santander.
Conflict of interest
Marc Miravitlles has received speaker fees from BoehringerIngelheim, Pfizer, AstraZeneca, Bayer Schering, Novartis, Talecris-Grifols, Takeda-Nycomed, Merck, and Sharp & Dohme and consulting fees from BoehringerIngelheim, Pfizer, GSK, AstraZeneca, Bayer Schering, Novartis, Almirall, Merck, Sharp & Dohme, Talecris-Grifols, and Takeda-Nycomed. Cristian de la Roza is a full time employee of Bayer Healthcare. The other authors have no conflicts of interest related to this manuscript.
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Miravitlles, M., García-Polo, C., Domenech, A. et al. Clinical Outcomes and Cost Analysis of Exacerbations in Chronic Obstructive Pulmonary Disease. Lung 191, 523–530 (2013). https://doi.org/10.1007/s00408-013-9487-z
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DOI: https://doi.org/10.1007/s00408-013-9487-z