Study of the Direct Costs of Asthma at a Healthcare Service Provider in Bogotá, Colombia.

OBJECTIVES: This study aimed to describe clinical characteristics and direct medical costs associated with disease treatment in Colombia patients with asthma from 1 healthcare provider. METHODS: This was a descriptive study with a retrospective data collection from a healthcare provider's electronic medical records in Colombia. A clinical, demographic, and healthcare resource utilization profile was developed over a 12-month observation period after the identification of eligible patients. To determine the mean cost per patient per year, the total frequencies of resource utilization were added, and the result was multiplied by the unit cost of each of them. RESULTS: A total of 7919 patients were included in the analysis. The mean ± SD cost per patient per year ranged from $189.5 ± $1.900.6 to $240.2 ± $1.903.6 depending on the price guidebook. The total cost had been driven by the medication use (79% of total cost) and by the outpatient visits (20% of total cost). CONCLUSIONS: In the population analyzed, the mean total direct cost per patient per year of asthma was $189.5 and $240.2, depending on the cost source. Direct medical costs were higher in cases classified as severe and in the adult and elderly population. When comparing the sources of resource utilization, it was found that the mean cost per patient obtained from real-life data is lower than the theoretical cost obtained from the bottom-up method with quantification of resources from experts. It is important to consider limitations related to study design and the evolving landscape of asthma treatments.

[Economic burden of methicillin-resistant Staphylococcus aureus bacteremia in critical care patients in hospitals in Bogotá]. / Impacto económico de la resistencia a la meticilina en pacientes con bacteriemia por Staphylococcus aureus en hospitales de Bogotá

INTRODUCTION: Resistant infections, especially those involving the bloodstream, are associated with a greater use of resources. Their estimates are variable and depend on the methodology used. Staphylococcus aureus is the main pathogen isolated in blood in our hospitals. There is no consolidated data about economic implications of methicillin-resistant S. aureus infection. OBJECTIVE: To describe the cost of care of methicillin-resistant S. aureus bacteremia in a reference population from nine hospitals in Bogotá. Materials y methods: A multicenter cohort study included 204 patients in a 1:1 ratio according to resistance. Direct medical costs were calculated from hospitalization bills, while the bacteremia period was calculated by applying microcosting based on standard fares. RESULTS: We found no significant differences between groups in demographic and clinical characteristics, except for resistance risk factors. Fifty-three percent of patients died during hospitalization. Hospital stay and total invoiced value during hospitalization were significantly higher in the group with methicillin-resistant S. aureus bacteremia. For this group, higher costs in ICU stay, antibiotics use, intravenous fluids, laboratory tests and respiratory support were recorded. A crude increase of 31% and an adjusted increase of 70% in care costs associated with methicillin resistance were registered. CONCLUSION: Our study supports decision makers in finding and funding infection prevention programs, especially those infections caused by resistant organisms.

Impacto económico de la resistencia a la meticilina en pacientes con bacteriemia por Staphylococcus aureus en hospitales de Bogotá / Economic burden of methicillin-resistant Staphylococcus aureus bacteremia in critical care patients in hospitals in Bogotá

Introducción. Las infecciones por microorganismos resistentes, especialmente las que involucran el torrente sanguíneo, se asocian a un mayor uso de recursos. Sus estimaciones son variables y dependen de la metodología utilizada. Staphylococcus aureus es el agente de sangre aislado con mayor frecuencia en nuestro medio. No existe información sobre el costo asociado con la atención de bacteriemias por S. aureus resistente a meticilina en nuestro país. Objetivo. Presentar una aproximación del costo de atención de las bacteriemias por S. aureus resistente a la meticilina en nueve hospitales de Bogotá. Materiales y métodos. Se incluyeron 204 pacientes en un estudio de cohortes multicéntrico en una razón de 1:1 según la resistencia. Se aproximaron los costos médicos directos con base en las facturas del período de hospitalización; en cuanto al período de la bacteriemia, los costos detallados se calcularon aplicando las tarifas estandarizadas. Resultados. No se encontraron diferencias significativas en las características clínicas y demográficas de los grupos, salvo en los antecedentes de la bacteriemia. El 53 % de los sujetos falleció durante la hospitalización. La estancia y el valor total facturado por la hospitalización fueron significativamente mayores en el grupo con bacteriemia por S. aureus resistente a la meticilina, así como los costos de la estancia en cuidados intensivos, de los antibióticos, los líquidos parenterales, los exámenes de laboratorio y la terapia respiratoria. El incremento crudo del costo de la atención asociado con la resistencia a meticilina fue de 31 % y, el ajustado, de 70 %. Conclusión. Este estudio constituye un respaldo a los tomadores de decisiones para la búsqueda y la financiación de programas de prevención de infecciones causadas por microorganismos resistentes.

Introduction: Resistant infections, especially those involving the bloodstream, are associated with a greater use of resources. Their estimates are variable and depend on the methodology used. Staphylococcus aureus is the main pathogen isolated in blood in our hospitals. There is no consolidated data about economic implications of methicillin-resistant S. aureus infection. Objective: To describe the cost of care of methicillin-resistant S. aureus bacteremia in a reference population from nine hospitals in Bogotá. Materials y methods: A multicenter cohort study included 204 patients in a 1:1 ratio according to resistance. Direct medical costs were calculated from hospitalization bills, while the bacteremia period was calculated by applying microcosting based on standard fares. Results: We found no significant differences between groups in demographic and clinical characteristics, except for resistance risk factors. Fifty-three percent of patients died during hospitalization. Hospital stay and total invoiced value during hospitalization were significantly higher in the group with methicillin-resistant S. aureus bacteremia. For this group, higher costs in ICU stay, antibiotics use, intravenous fluids, laboratory tests and respiratory support were recorded. A crude increase of 31% and an adjusted increase of 70% in care costs associated with methicillin resistance were registered. Conclusion: Our study supports decision makers in finding and funding infection prevention programs, especially those infections caused by resistant organisms.

Mortality among critically ill patients with methicillin-resistant Staphylococcus aureus bacteremia: a multicenter cohort study in Colombia / Mortalidad en pacientes gravemente enfermos con bacteriemia por Staphylococcus aureus resistente a la meticilina:un estudio multicéntrico de cohortes en Colombia

Objetivo. Evaluar los factores de riesgo asociados con la aparición de bacteriemia por Staphylococcus aureus resistente a la meticilina (MRSA), su pronóstico y los factores determinantes de la mortalidad en pacientes gravemente enfermos en Colombia. Métodos. Estudio retrospectivo multicéntrico de cohortes realizado en el período del 2005 al 2008 en 16 instituciones de atención de salud de referencia públicas y privadas de Bogotá, Colombia, que forman parte de una red nacional de vigilancia epidemiológica y de una red hospitalaria de 4 469 camas. Se analizaron la aparición de resistencia a la meticilina y la mortalidad mediante análisis descriptivos y de tiempo transcurrido hasta un suceso; se estableció un modelo multifactorial de regresión de riesgos proporcionales de Cox para evaluar la asociación entre la resistencia a la meticilina y la mortalidad. Resultados. Se estudiaron 372 pacientes: 186 con bacteriemia por MRSA, apareados aleatoriamente con 186 con bacteriemia por Staphylococcus aureus sensible a la meticilina (MSSA). La cirugía previa, el tratamiento con antibióticos y las infecciones intrahospitalarias se asociaron independientemente con la resistencia a la meticilina. El MRSA provocó hospitalizaciones más prolongadas en los sobrevivientes (mediana de 24 frente a 18 días, P = 0,014). Los factores predictivos de mortalidad fueron: la edad del paciente, un nivel de creatinina superior a 1,21 mg/dl al ingresar en la UCI, la septicemia grave y el requerimiento de inotrópicos. El tratamiento antimicrobiano apropiado y el cambio de tratamiento antimicrobiano constituyeron factores protectores independientes, igual que el sexo masculino. Conclusiones. La resistencia a la meticilina per se no fue un factor pronóstico independiente de la mortalidad. Las condiciones previas, como la edad, la insuficiencia renal inicial, la septicemia grave y el requerimiento de inotrópicos explicaron la mortalidad observada. El tratamiento antimicrobiano apropiado seguía siendo un factor protector. Es obligatorio hacer un llamamiento para mejorar las medidas de control de las infecciones en Colombia y en otros contextos similares.

Objective. To evaluate risk factors associated with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia emergence, its prognosis, and mortality-determining factors in critically ill patients in Colombia. Methods. A multicenter, retrospective cohort study conducted in 2005–2008 at 16 public and private reference health care institutions in Bogotá, Colombia, that form part of a national epidemiological surveillance network and a hospital network with 4 469 beds. Methicillinresistant emergence and mortality were analyzed using descriptive and time-to-event analysis; a multivariate Cox proportional hazard regression model was built to test the association between methicillin resistance and mortality. Results. A total of 372 patients were studied: 186 with MRSA bacteremia, randomly matched with 186 with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. Previous surgery, antibiotic exposure, and hospital-acquired infections were independently associated with methicillin resistance. MRSA caused longer hospital stays among survivors (median 24 versus 18 days, P = 0.014). Mortality predictors were: patient age, creatinine level over 1.21mg/dl at ICU admission, severe sepsis, and inotropic requirement. Appropriate antimicrobial therapy and antimicrobial therapy change were independent protective factors, as was male gender. Conclusions. Methicillin resistance per se was not a mortality-independent prognostic factor. Previous conditions, such as age, baseline renal impairment, severe sepsis, and inotropy demand explained the observed mortality. Appropriate antimicrobial therapy remained a protective factor. A call to improve infection control measures in Colombia is mandatory.

Mortality among critically ill patients with methicillin-resistant Staphylococcus aureus bacteremia: a multicenter cohort study in Colombia.

OBJECTIVE: To evaluate risk factors associated with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia emergence, its prognosis, and mortality-determining factors in critically ill patients in Colombia. METHODS: A multicenter, retrospective cohort study conducted in 2005-2008 at 16 public and private reference health care institutions in Bogotá, Colombia, that form part of a national epidemiological surveillance network and a hospital network with 4 469 beds. Methicillin-resistant emergence and mortality were analyzed using descriptive and time-to-event analysis; a multivariate Cox proportional hazard regression model was built to test the association between methicillin resistance and mortality. RESULTS: A total of 372 patients were studied: 186 with MRSA bacteremia, randomly matched with 186 with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. Previous surgery, antibiotic exposure, and hospital-acquired infections were independently associated with methicillin resistance. MRSA caused longer hospital stays among survivors (median 24 versus 18 days, P = 0.014). Mortality predictors were: patient age, creatinine level over 1.21 mg/dl at ICU admission, severe sepsis, and inotropic requirement. Appropriate antimicrobial therapy and antimicrobial therapy change were independent protective factors, as was male gender. CONCLUSIONS: Methicillin resistance per se was not a mortality-independent prognostic factor. Previous conditions, such as age, baseline renal impairment, severe sepsis, and inotropy demand explained the observed mortality. Appropriate antimicrobial therapy remained a protective factor. A call to improve infection control measures in Colombia is mandatory.