[Direct costs to primary care of chronic bronchitis. Analysis of a prospective study]. / Costes directos de la bronquitis crónica en atención rimaria. Análisis de un estudio prospectivo.

OBJECTIVE: To evaluate the consumption of the direct health resources of primary care (PC) in Spain by a cohort of patients with chronic bronchial pathology: chronic bronchitis (CB) and chronic obstructive pulmonary disease (COPD). DESIGN: Prospective cohort study of patients with CB and COPD monitored in PC in Spain. The first 10 adult patients who attended at random each researcher's clinic and who were diagnosed as suffering an exacerbation of their chronic bronchial pathology were included. Scheduled follow-up visits for a year evaluated the cohort's consumption of health resources. Direct health costs were analysed. RESULTS: 268 doctors, with 2414 patients, took part. 1510 patients completed the 12 months follow-up (62.6%). All the patients received pharmacological treatment for their pulmonary disease. The most common complementary investigations performed were: general blood analysis (1.5 per patient/year), chest x-ray (1.2) and ECG (0.9), followed by spirometry (0.5) and arterial gasometry (0.4). Mean number of exacerbations per year were 1.9; and admissions, 0.2. Overall cost, including tests, medical visits, hospital expenditure and pharmacological treatment, was 420,264,000 pesetas for the entire cohort. The direct annual cost per patient ran at 278,321 pesetas. The cost caused by patients treated with Cefixime on the first exacerbations was 77,365 pesetas less, which was mostly due to less hospital expense. CONCLUSIONS: The direct annual cost per patient with CB or COPD is high, above the cost of other chronic respiratory pathologies such as bronchial asthma. There are notably greater hospital costs for CB and COPD, explained by these patients' mean greater age and the non-reversible and progressive deterioration of their respiratory function.

Cost-effectiveness of management strategies for acute urethritis in the developing world.

OBJECTIVE: To recommend a cost-effective approach for the management of acute male urethritis in the developing world, based on the findings of a theoretical study. METHODS: A model was developed to assess the cost-effectiveness of three urethritis management strategies in a theoretical cohort of 1000 men with urethral syndrome. (1) All patients were treated with cefixime and doxycycline for gonococcal urethritis (GU) and nongonococcal urethritis (NGU), respectively, as recommended by WHO. (2) All patients were treated with doxycycline for NGU; treatment with cefixime was based on the result of direct microscopy of a urethral smear. (3) All patients were treated with cotrimoxazole or kanamycin for GU and doxycycline for NGU. Cefixime was kept for patients not responding to the first GU treatment. Strategy costs included consultations, laboratory diagnosis (where applicable) and drugs. The outcome was the rate of patients cured of urethritis. Cost-effectiveness was measured in terms of cost per cured urethritis. RESULTS: Strategy costs in our model depended largely on drug costs. The first strategy was confirmed as the most effective but also the most expensive approach. Cefixime should cost no more than US$ 1.5 for the strategy to be the most cost-effective. The second strategy saved money and drugs but proved a valuable alternative only when laboratory performance was optimal. The third strategy with cotrimoxazole was the least expensive but a low follow-up visit rate, poor treatment compliance or lower drug efficacy limited effectiveness. Maximizing compliance by replacing cotrimoxazole with single-dose kanamycin had the single greatest impact on the effectiveness of the third strategy. CONCLUSION: Our model suggested that a cost-effective approach would be to treat gonorrhoea with a single-dose antibiotic selected from locally available products that cost no more than US$ 1.5.

Sequential antimicrobial therapy: treatment of severe lower respiratory tract infections in children.

Although there have been a number of studies in adults, to date there has been little research into sequential antimicrobial therapy (SAT) in paediatric populations. The present study evaluates the impact of a SAT protocol for the treatment of severe lower respiratory tract infection in paediatric patients. The study involved 89 paediatric patients (44 control and 45 SAT). The SAT patients had a shorter length of hospital stay (4.0 versus 8.3 days), shorter duration of inpatient antimicrobial therapy (4.0 versus 7.9 days) with the period of iv therapy being reduced from a mean of 5.6 to 1.7 days. The total healthcare costs were reduced by 52%. The resolution of severe lower respiratory tract infection with a short course of iv antimicrobials, followed by conversion to oral therapy yielded clinical outcomes comparable to those achieved using longer term iv therapy. SAT proved to be an important cost-minimizing tool for realizing substantial healthcare costs savings.