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2.
Expert Rev Pharmacoecon Outcomes Res ; 19(6): 685-692, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31847613

RESUMO

Introduction: Governments need to do far more to help curb the emergence and transmission of antibiotic resistance and help protect the efficacy of any new antibiotics that come to the market. Industry is an important stakeholder that must be brought on-board such efforts given its influence on the direction and scale of antibiotic sales. Financial incentives supporting industry R&D of novel antibiotics should structurally remove the drivers of superfluous sales and encourage access to newer antibiotics where infections are otherwise resistant to treatment. Indeed, the use of public money provides an important opportunity to prioritize these public health goals within market structures such that we both adequately reward industry for their efforts and prolong antibiotic efficacy for as long as possible.Areas covered: This work discusses possible financial 'pull' incentives that fully delink the reward paid to the developer from unit sales, examining their primary advantages and limitations.Expert opinion: Pharmaceutical companies need to be rewarded generously for their efforts to develop new, badly needed antibiotics. But the current marketplace does not provide a sustained financial lure and its reliance on unit-sales for profitability jeopardizes the efficacy of antibiotics both new and old. Fully delinked models can make antibiotic R&D more financially appealing and create a market environment that is far less threatening to public health.


Assuntos
Antibacterianos/farmacologia , Indústria Farmacêutica/economia , Farmacorresistência Bacteriana , Antibacterianos/economia , Comércio/economia , Desenvolvimento de Medicamentos/economia , Humanos , Saúde Pública/economia , Apoio à Pesquisa como Assunto/economia
3.
BMC Health Serv Res ; 19(1): 743, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651305

RESUMO

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is an opportunistic bacterial organism resistant to first line antibiotics. Acquisition of MRSA is often classified as either healthcare-associated or community-acquired. It has been shown that both healthcare-associated and community-acquired infections contribute to the spread of MRSA within healthcare facilities. The objective of this study was to estimate the incremental inpatient cost and length of stay for individuals colonized or infected with MRSA. Common analytical methods were compared to ensure the quality of the estimate generated. This study was performed at Alberta Ministry of Health (Edmonton, Alberta), with access to clinical MRSA data collected at two Edmonton hospitals, and ministerial administrative data holdings. METHODS: A retrospective cohort study of patients with MRSA was identified using a provincial infection prevention and control database. A coarsened exact matching algorithm, and two regression models (semilogarithmic ordinary least squares model and log linked generalized linear model) were evaluated. A MRSA-free cohort from the same facilities and care units was identified for the matched method; all records were used for the regression models. Records span from January 1, 2011 to December 31, 2015, for individuals 18 or older at discharge. RESULTS: Of the models evaluated, the generalized linear model was found to perform the best. Based on this model, the incremental inpatient costs associated with hospital-acquired cases were the most costly at $31,686 (14,169 - 60,158) and $47,016 (23,125 - 86,332) for colonization and infection, respectively. Community-acquired MRSA cases also represent a significant burden, with incremental inpatient costs of $7397 (2924 - 13,180) and $14,847 (8445 - 23,207) for colonization and infection, respectively. All costs are adjusted to 2016 Canadian dollars. Incremental length of stay followed a similar pattern, where hospital-acquired infections had the longest incremental stays of 35.2 (16.3-69.5) days and community-acquired colonization had the shortest incremental stays of 3.0 (0.6-6.3) days. CONCLUSIONS: MRSA, and in particular, hospital-acquired MRSA, places a significant but preventable cost burden on the Alberta healthcare system. Estimates of cost and length of stay varied by the method of analysis and source of infection, highlighting the importance of selecting the most appropriate method.


Assuntos
Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/economia , Idoso , Alberta , Antibacterianos/economia , Antibacterianos/uso terapêutico , Estudos de Coortes , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/economia , Infecção Hospitalar/economia , Infecção Hospitalar/prevenção & controle , Feminino , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Meticilina/economia , Meticilina/uso terapêutico , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
Artigo em Inglês | MEDLINE | ID: mdl-31547325

RESUMO

The over-use of antibiotics has been identified as a major global challenge, where there is insufficient knowledge about the use of antibiotics in primary healthcare settings, especially at a population level. This study aims to investigate the trends and patterns of antibiotic sales in primary care in Hubei, China over a six-year period from 2012 to 2017. Antibiotic sales were expressed with Defined Daily Doses per 1000 inhabitants per day (DIDs) and compared with European countries using the 12 quality indicators proposed by the scientific advisory board of the European Surveillance of Antimicrobial Consumption (ESAC) project. Antibiotic sales increased from 12.8 DID in 2012 to 15.3 DID in 2013, and then declined afterwards. The most commonly used antibiotics, J01C (beta-lactam antimicrobials, penicillins), accounted for 40.5% of total antibiotic sales. Parenteral administration of antibiotics accounted for over 50% of total antibiotic sales. Total antibiotic sales were almost on a par with the 31 European countries monitored by the ESAC project, but cephalosporin sales were higher than at least three quarters of the compared countries, resulting in a significant higher proportion of third-generation cephalosporin consumption (13.8-19.43%). The relative consumption of Fluoroquinolone (9.26-9.89%) was also higher than at least half of the compared countries. There is a lack of robust evidence to show that antibiotic consumption in primary care is lower in Hubei compared with other countries. The preference of clinicians in China to use broad-spectrum and parenteral antibiotics deserves further study and policy attention.


Assuntos
Antibacterianos/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Antibacterianos/classificação , Antibacterianos/economia , China , Comércio , Uso de Medicamentos/economia , Humanos
6.
Molecules ; 24(17)2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31470632

RESUMO

Antimicrobial resistance in bacteria is frightening, especially resistance in Gram-negative Bacteria (GNB). In 2017, the World Health Organization (WHO) published a list of 12 bacteria that represent a threat to human health, and among these, a majority of GNB. Antibiotic resistance is a complex and relatively old phenomenon that is the consequence of several factors. The first factor is the vertiginous drop in research and development of new antibacterials. In fact, many companies simply stop this R&D activity. The finding is simple: there are enough antibiotics to treat the different types of infection that clinicians face. The second factor is the appearance and spread of resistant or even multidrug-resistant bacteria. For a long time, this situation remained rather confidential, almost anecdotal. It was not until the end of the 1980s that awareness emerged. It was the time of Vancomycin-Resistance Enterococci (VRE), and the threat of Vancomycin-Resistant MRSA (Methicillin-Resistant Staphylococcus aureus). After this, there has been renewed interest but only in anti-Gram positive antibacterials. Today, the threat is GNB, and we have no new molecules with innovative mechanism of action to fight effectively against these bugs. However, the war against antimicrobial resistance is not lost. We must continue the fight, which requires a better knowledge of the mechanisms of action of anti-infectious agents and concomitantly the mechanisms of resistance of infectious agents.


Assuntos
Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana Múltipla , Drogas em Investigação/uso terapêutico , Enterobacteriaceae/efeitos dos fármacos , Saúde Global/tendências , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/patogenicidade , Acinetobacter baumannii/fisiologia , Aminoglicosídeos/síntese química , Aminoglicosídeos/economia , Aminoglicosídeos/uso terapêutico , Antibacterianos/síntese química , Antibacterianos/economia , Aprovação de Drogas/organização & administração , Drogas em Investigação/síntese química , Drogas em Investigação/economia , Enterobacteriaceae/patogenicidade , Enterobacteriaceae/fisiologia , Fluoroquinolonas/síntese química , Fluoroquinolonas/economia , Fluoroquinolonas/uso terapêutico , Saúde Global/economia , Glicopeptídeos/síntese química , Glicopeptídeos/economia , Glicopeptídeos/uso terapêutico , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/patogenicidade , Bactérias Gram-Negativas/fisiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/patologia , Humanos , Macrolídeos/síntese química , Macrolídeos/economia , Macrolídeos/uso terapêutico , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/patogenicidade , Pseudomonas aeruginosa/fisiologia , beta-Lactamas/síntese química , beta-Lactamas/economia , beta-Lactamas/uso terapêutico
7.
BMC Health Serv Res ; 19(1): 561, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31409413

RESUMO

BACKGROUND: Bronchiectasis in children is an important, but under-researched, chronic pulmonary disorder that has negative impacts on health-related quality of life. Despite this, it does not receive the same attention as other chronic pulmonary conditions in children such as cystic fibrosis. We measured health resource use and health-related quality of life over a 12-month period in children with bronchiectasis. METHODS: We undertook a prospective cohort study of 85 children aged < 18-years with high-resolution chest computed-tomography confirmed bronchiectasis undergoing management in three pediatric respiratory medical clinics in Darwin and Brisbane, Australia and Auckland, New Zealand. Children with cystic fibrosis or receiving cancer treatment were excluded. Data collected included the frequency of healthcare attendances (general practice, specialists, hospital and/or emergency departments, and other), medication use, work and school/childcare absences for parents/carers and children respectively, and both parent/carer and child reported quality of life and cough severity. RESULTS: Overall, 951 child-months of observation were completed for 85 children (median age 8.7-years, interquartile range 5.4-11.3). The mean (standard deviation) number of exacerbations was 3.3 (2.2) per child-year. Thirty of 264 (11.4%) exacerbation episodes required hospitalization. Healthcare attendance and antibiotic use rates were high (30 and 50 per 100 child-months of observation respectively). A carer took leave from work for 53/236 (22.5%) routine clinic visits. Absences from school/childcare due to bronchiectasis were 24.9 children per 100 child-months. Quality of life scores for both the parent/carer and child were highly-correlated with one another, remained stable over time and were negatively associated with cough severity. CONCLUSIONS: Health resource use in this cohort of children is high, reflecting their severe disease burden. Studies are now needed to quantify the direct and societal costs of disease and to evaluate interventions that may reduce disease burden, particularly hospitalizations.


Assuntos
Antibacterianos/uso terapêutico , Bronquiectasia/terapia , Hospitalização/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , Qualidade de Vida , Antibacterianos/economia , Bronquiectasia/economia , Bronquiectasia/epidemiologia , Criança , Pré-Escolar , Progressão da Doença , Feminino , Necessidades e Demandas de Serviços de Saúde , Hospitalização/economia , Humanos , Masculino , Projetos Piloto , Estudos Prospectivos
8.
Eur J Med Chem ; 182: 111639, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31470306

RESUMO

Amphiphilic kanamycins bearing hydrophobic modifications at the 6″ position have attracted interest due to remarkable antibacterial-to-antifungal switches in bioactivity. In this report, we investigate a hurdle that hinders practical applications of these amphiphilic kanamycins: a cost-effective synthesis that allows the incorporation of various connecting functionalities to which the hydrophobic moieties are connected to the kanamycin core. A cost-effective tosylation enables various modifications at the 6″ position, which is scalable to a 90-g scale. The connecting functionalities, such as amine and thiol, were not the dominant factor for biological activity. Instead, the linear chain length played the decisive role. Amphiphilic kanamycin attached with tetradecyl (C14) or hexadecyl (C16) showed strong antifungal and modest antibacterial activities than with shorter chains (C6-C10). However, increases in chain length were closely correlated with an increase in HeLa cell toxicity. Thus, a compromise between the antimicrobial activities and cytotoxicities, for optimal efficacy of amphiphilic kanamycins may contain chain lengths between C8 and C12. Finally, the described synthetic protocol also allows the preparation of a fluorescent amphiphilic kanamycin selective toward fungi.


Assuntos
Antibacterianos/farmacologia , Antifúngicos/farmacologia , Bactérias/efeitos dos fármacos , Fungos/efeitos dos fármacos , Canamicina/farmacologia , Tensoativos/farmacologia , Antibacterianos/química , Antibacterianos/economia , Antifúngicos/química , Antifúngicos/economia , Sobrevivência Celular/efeitos dos fármacos , Análise Custo-Benefício , Relação Dose-Resposta a Droga , Células HeLa , Humanos , Interações Hidrofóbicas e Hidrofílicas , Canamicina/química , Canamicina/economia , Testes de Sensibilidade Microbiana , Estrutura Molecular , Relação Estrutura-Atividade , Tensoativos/química , Tensoativos/economia
9.
BMC Infect Dis ; 19(1): 650, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331272

RESUMO

BACKGROUND: This study aimed to evaluate the oral switch (OS) stewardship intervention in the intensive care unit (ICU). METHODS: This was a retrospective study with a convenience sample in two Brazilian ICUs from different hospitals in patients with sepsis receiving antibiotic therapy. The stewardship intervention included OS in patients diagnosed with sepsis when clinical stability was achieved. The primary outcome was overall mortality. Other variables evaluated were as follows: cost of antimicrobial treatment, daily costs of intensive care, acute kidney injury, and length of stay. RESULTS: There was no difference in mortality between the OS and non-OS groups (p = 0.06). Length of stay in the ICU (p = 0.029) was shorter and acute kidney injury incidence (p = 0.032) and costs of antimicrobial therapy (p < 0.001) were lower in the OS group. CONCLUSION: OS stewardship programs in the ICU may be considered a safe strategy. Switch therapy reduced the cost and shortened the length of stay in ICUs.


Assuntos
Antibacterianos/administração & dosagem , Bacteriemia/tratamento farmacológico , Bacteriemia/mortalidade , Lesão Renal Aguda/induzido quimicamente , Administração Intravenosa , Administração Oral , Idoso , Antibacterianos/economia , Antibacterianos/uso terapêutico , Bacteriemia/economia , Brasil , Custos e Análise de Custo , Estudos Transversais , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
10.
Cornea ; 38(8): 933-937, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31276456

RESUMO

PURPOSE: To understand medication use and patient burden for treatment of bacterial keratitis (BK). METHODS: A retrospective study was conducted examining medical records of adult patients with BK in an academic cornea practice. Data collected included medications used in the treatment of BK, dosing of medications, and the number and total duration of clinical encounters. Costs of medications were estimated using the average wholesale pharmacy price. Linear regression analysis was used to investigate associations of medication use with patient demographics and corneal culture results and reported with beta estimates (ß) and 95% confidence intervals (95% CIs). RESULTS: Forty-eight patients with BK (56% female) were studied. Patients were treated for a median of 54 days with 10 visits, 5 unique medications, 587 drops, and 7 prescriptions. The estimated median medication cost was $933 (interquartile range: $457-$1422) US dollars. Positive bacterial growth was significantly associated with more visits (ß: 6.16, 95% CI: 1.75-10.6, P = 0.007), more days of treatment (ß: 86.8, 95% CI: 10.8-163, P = 0.026), more prescribed medications (ß: 2.86, 95% CI: 1.04-4.67, P = 0.003), and more doses of medications (ß: 796, 95% CI: 818-1412, P = 0.012) compared with patients who did not undergo corneal scraping. Patients were prescribed 132 more drops of medication for every 10 years of older age (ß: 132, 95% CI: 18.2-246, P = 0.024). Sex and income were not associated with medication burden or treatment length. CONCLUSIONS: Older patients and those with positive cultures incur the most medication burden in treatment of BK. Providers should be aware of medication usage and cost burden as it may affect compliance with treatment.


Assuntos
Antibacterianos/economia , Antibacterianos/uso terapêutico , Úlcera da Córnea/tratamento farmacológico , Custos e Análise de Custo , Custos de Medicamentos , Uso de Medicamentos/estatística & dados numéricos , Infecções Oculares Bacterianas/tratamento farmacológico , Administração Oftálmica , Bactérias/isolamento & purificação , Úlcera da Córnea/microbiologia , Prescrições de Medicamentos/estatística & dados numéricos , Infecções Oculares Bacterianas/microbiologia , Feminino , Glucocorticoides/economia , Glucocorticoides/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Midriáticos/economia , Midriáticos/uso terapêutico , Soluções Oftálmicas , Estudos Retrospectivos
11.
Braz J Infect Dis ; 23(4): 237-245, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31344357

RESUMO

BACKGROUND: Recent studies suggest that sustained use of generic antibiotics may be associated with clinical failure and emergence of antibacterial resistance. The present study was designed to determine the clinical outcome between the use of generic meropenem (GM) and brand-name meropenem (BNM). Additionally, this study evaluated the economic impact of GM and BNM to determine if the former represents a cost-effective alternative to the latter. METHODS: Patients treated between January 2011 and May 2014 received GM while patients treated between June 2014 and March 2017 received BNM. Mortality was compared between groups. Total infection cost was defined by the cost of antimicrobial consumption, length of stay, and laboratory and imaging exams until infection resolution. FINDINGS: A total of 168 patients were included; survival rate for the 68 patients treated with GM was 38% compared to 59% in the patients treated with BNM. Multivariate analysis showed that the variables most strongly-associated with mortality were cardiovascular disease (OR 18.18, 95% CI 1.25-262.3, p = 0.033) and treatment with generic meropenem (OR 18.45, 95% CI 1.45-232.32, p = 0.024). On the other hand, total infection cost did not show a significant difference between groups (BNM $10,771 vs. GM $11,343; p = 0.91). INTERPRETATION: The present study suggests that patients treated with GM have a risk of death 18 times higher compared to those treated with BNM. Furthermore, economic analysis shows that GM is not more cost effective than BNM. SUMMARY: More studies measuring clinical outcomes are needed to confirm the clinical equivalence of brand-name versus generic antibiotics, not only for meropenem but also for other molecules.


Assuntos
Antibacterianos/economia , Antibacterianos/uso terapêutico , Medicamentos Genéricos/economia , Medicamentos Genéricos/uso terapêutico , Unidades de Terapia Intensiva/economia , Meropeném/economia , Meropeném/uso terapêutico , Adolescente , Adulto , Distribuição por Idade , Idoso , Colômbia , Análise Custo-Benefício , Feminino , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/mortalidade , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco , Distribuição por Sexo , Análise de Sobrevida , Centros de Atenção Terciária/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
12.
Trials ; 20(1): 463, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31358032

RESUMO

BACKGROUND: Differentiating infection from inflammation in acute pancreatitis is difficult, leading to overuse of antibiotics. Procalcitonin (PCT) measurement is a means of distinguishing infection from inflammation as levels rise rapidly in response to a pro-inflammatory stimulus of bacterial origin and normally fall after successful treatment. Algorithms based on PCT measurement can differentiate bacterial sepsis from a systemic inflammatory response. The PROCalcitonin-based algorithm for antibiotic use in Acute Pancreatitis (PROCAP) trial tests the hypothesis that a PCT-based algorithm to guide initiation, continuation and discontinuation of antibiotics will lead to reduced antibiotic use in patients with acute pancreatitis and without an adverse effect on outcome. METHODS: This is a single-centre, randomised, controlled, single-blind, two-arm pragmatic clinical and cost-effectiveness trial. Patients with a clinical diagnosis of acute pancreatitis will be allocated on a 1:1 basis to intervention or standard care. Intervention will involve the use of a PCT-based algorithm to guide antibiotic use. The primary outcome measure will be the binary outcome of antibiotic use during index admission. Secondary outcome measures include: safety non-inferiority endpoint all-cause mortality; days of antibiotic use; clinical infections; new isolates of multiresistant bacteria; duration of inpatient stay; episode-related mortality and cause; quality of life (EuroQol EQ-5D); and cost analysis. A 20% absolute change in antibiotic use would be a clinically important difference. A study with 80% power and 5% significance (two-sided) would require 97 patients in each arm (194 patients in total): the study will aim to recruit 200 patients. Analysis will follow intention-to-treat principles. DISCUSSION: When complete, PROCAP will be the largest randomised trial of the use of a PCT algorithm to guide initiation, continuation and cessation of antibiotics in acute pancreatitis. PROCAP is the only randomised trial to date to compare standard care of acute pancreatitis as defined by the International Association of Pancreatology/American Pancreatic Association guidelines to patients having standard care but with all antibiotic prescribing decisions based on PCT measurement. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number, ISRCTN50584992. Registered on 7 February 2018.


Assuntos
Algoritmos , Antibacterianos/uso terapêutico , Técnicas de Apoio para a Decisão , Monitoramento de Medicamentos/métodos , Pancreatite/tratamento farmacológico , Pró-Calcitonina/sangue , Antibacterianos/efeitos adversos , Antibacterianos/economia , Biomarcadores/sangue , Tomada de Decisão Clínica , Ensaios Clínicos Fase III como Assunto , Redução de Custos , Análise Custo-Benefício , Custos de Medicamentos , Monitoramento de Medicamentos/economia , Inglaterra , Humanos , Pancreatite/sangue , Pancreatite/diagnóstico , Pancreatite/economia , Ensaios Clínicos Pragmáticos como Assunto , Valor Preditivo dos Testes , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento
16.
PLoS One ; 14(5): e0216770, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31100088

RESUMO

INTRODUCTION: Antibiotics are among the most commonly misused of all drugs, which results in antibiotic resistance and waste of resources and it has not been studied in Ethiopia. Therefore, this study was carried out to assess antibiotic use-related problems and their costs among patients hospitalized at the surgical ward of Jimma University Medical Center. METHODS: Hospital-based prospective observational study was used to assess the prevalence, cost, and determinants of antibiotic use-related problems; multiple stepwise backward logistic regression analysis was done for a P value of < 0.25 to look for predictors of antibiotic use-related problems. Written informed consent was obtained and confidentiality was secured. RESULTS: Among 300 participants, antibiotic use-related problems (ABURPs) were found in 69.3% of the study participants. The direct total cost attributed to these problems was approximated to a minimum of 2230.15 US$. Independent predictors for antibiotic use-related problems were: indication for antibiotic use like: use of antibiotic for prophylaxis; p < 0.0001, antibiotic use for both therapeutic & prophylaxis; p < 0.0001, CDC wound class I and II; p = 0.016 and; p = 0.002 respectively, overall poly-pharmacy and greater than 2 antibiotic exposure during hospital stay; p = 0.019and p = 0.006 respectively and hospital stay for ≥21 days; p = 0.007. CONCLUSION: The prevalence of antibiotic use-related problems was high and resulted in extra cost. Antibiotic use for prophylaxis, prophylaxis, and treatment, poly-pharmacy, greater than 2 antibiotic exposures during the hospital stay, CDC wound class I and II, and duration of hospital stay of ≥ 21 days was found to be independent predictors of antibiotic use-related problems.


Assuntos
Antibacterianos/efeitos adversos , Uso Indevido de Medicamentos sob Prescrição/efeitos adversos , Centros Médicos Acadêmicos , Adolescente , Adulto , Antibacterianos/economia , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/efeitos adversos , Antibioticoprofilaxia/economia , Antibioticoprofilaxia/estatística & dados numéricos , Custos e Análise de Custo , Etiópia/epidemiologia , Feminino , Humanos , Prescrição Inadequada/efeitos adversos , Prescrição Inadequada/economia , Prescrição Inadequada/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Uso Indevido de Medicamentos sob Prescrição/economia , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , Prevalência , Estudos Prospectivos , Centro Cirúrgico Hospitalar , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/economia , Infecção da Ferida Cirúrgica/prevenção & controle , Adulto Jovem
17.
Prev Vet Med ; 168: 95-102, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31097130

RESUMO

Mycoplasma hyopneumoniae (Mhyo) is generally accepted to be the most common porcine respiratory pathogen worldwide causing big economical losses in swine production by affecting pig's downstream performance. The objective of this study was to develop a partial budget model to determine the payback period and economic value of two Mhyo elimination protocols. Retrospective data recorded from 2004 to 2017 from 70 breeding herds that implemented herd closure or whole-herd medication protocol targeting Mhyo elimination. Close out data was used to estimate differences in downstream performance between Mhyo-negative and positive flows. Assuming a 5000 sows breed-to-finish operation producing 135,870 weaned pigs and 125,000 finishing pigs/year, the total cost for implementing Mhyo elimination was $112,100 using the herd closure protocol, and $185,700 for the medication protocol. Statistically differences (p < 0.05) in downstream performance were observed for ADG and mortality, but not for feed conversion rate. The parameters that accounts for the greatest benefits were related to the improvement in ADG, savings in antibiotic medication in growing pigs and improvement in feed conversion rate. The benefit of Mhyo elimination was $877,375 per farm per year, or $7.00 per pig marketed. The estimated project value after 1 year was $616,121 for the herd closure considering a probability of success of 83%, and $323,177 for the medication protocol for 58% chance of success. The project value reached the break-even point when the cost per sow was $145.64 for the herd closure and $101.78 for the medication protocol. The payback period was 2 months after the start of marketing Mhyo-negative pigs for the herd closure, and 7 months for the medication protocol adjusted for the probability of success for each protocol. The protocols described here can be easily applied with a good success rate and showing that the benefits obtained are greater than the costs of project failure. Even if the farm stayed negative only a year, the economic benefits downstream are worth the investment. This information may help producers and veterinarians on decision-making process to conduct a Mhyo elimination protocol in their herds.


Assuntos
Mycoplasma hyopneumoniae , Pneumonia Suína Micoplasmática/economia , Doenças dos Suínos/economia , Agricultura/economia , Ração Animal , Animais , Antibacterianos/economia , Antibacterianos/uso terapêutico , Vacinas Bacterianas/administração & dosagem , Vacinas Bacterianas/economia , Análise Custo-Benefício , Feminino , Modelos Econômicos , Pneumonia Suína Micoplasmática/prevenção & controle , Suínos , Doenças dos Suínos/prevenção & controle , Fatores de Tempo
19.
Einstein (Sao Paulo) ; 17(4): eGS4444, 2019 May 16.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31116310

RESUMO

OBJECTIVE: To estimate the direct medical costs of drug therapy of Klebsiella pneumoniae carbapenemase (KPC) infection patients in hospital-based context. METHODS: A cost-of-illness study conducted with a prospective cohort design with hospitalized adults infected by KPC. Data collection was performed using an instrument composed of sociodemographic data, clinical and prescription medication. Estimates of the direct costs associated to each treatment were derived from the payer's perspective, in the case of federal public hospitals from Brazil, and included only drug costs. These costs were based on the average price available at the Brazilian Price Database Health. No discount rate was used for the cost of drugs. The costs are calculate in American Dollar (US$). RESULTS: A total of 120 inpatients participated of this study. The total drug cost of these inpatients was US$ 367,680.85. The systemic antimicrobial group was responsible for 59.5% of total costs. The direct drug cost per patients infected by KPC was conservatively estimated at nearly US$ 4,100.00, and about of 60% of costs occurred during the period of infection. CONCLUSION: The findings of our study indicate a thoughtful economic hazard posed by KPC that all healthcare sectors have to face. The increasing worldwide incidence of these bacteria represents a growing burden that most health systems are unable to deal with. There is an imperative need to develop protocols and new antimicrobials to treatment of KPC, aiming to rearrange resources to increase the effectiveness of healthcare services.


Assuntos
Antibacterianos/economia , Hospitalização/economia , Infecções por Klebsiella/economia , Klebsiella pneumoniae , Antibacterianos/administração & dosagem , Proteínas de Bactérias , Feminino , Custos de Cuidados de Saúde , Hospitalização/estatística & dados numéricos , Humanos , Pacientes Internados , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/enzimologia , Klebsiella pneumoniae/isolamento & purificação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , beta-Lactamases
20.
Int J Clin Pharmacol Ther ; 57(9): 429-436, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31131825

RESUMO

OBJECTIVE: Surgical site infections (SSIs) are considered to be one of the most common complications in operative treatment due to increased microbiological resistance. Having knowledge of the flora that most frequently cause SSIs in a given population allows for the implementation of effective empirical antibiotic therapies. Such an approach leads to a decrease in both time and costs associated with SSI treatment. The aim of this paper is to assess the most common pathogens causing SSIs in orthopedic and general surgery and to conduct a cost-minimization analysis. MATERIALS AND METHODS: A total of 908 isolates from 547 patients with an SSI in general surgery and 463 swabs from 267 patients with an SSI at the department of orthopedics were obtained. All patients were treated at St. John of God Hospital in Katowice from 2011 to 2016. RESULTS: The incidence rate of SSIs was 4.25% in general surgery and 2.66% in orthopedics. The most commonly isolated strains in general surgery were E. coli (24.3%), K. pneumoniae (12.5%), and P. mirabilis (4.76%). Gram-positive cocci dominated the isolates in orthopedics, with S. epidermidis and S. aureus accounting for 19.8% and 13.6%, respectively. The most cost-effective antibiotics for general surgery are currently the cephalosporins cefotaxime or ceftriaxone, either alone or in combination with amikacin, while in orthopedics the most cost-effective were trimethoprim/sulfamethoxazole. CONCLUSION: Empirical antibiotic therapy should be based on the current epidemiological situation of infections from both a medical and pharmacoeconomic point of view.


Assuntos
Antibacterianos/economia , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Farmacoeconomia , Infecção da Ferida Cirúrgica/tratamento farmacológico , Humanos
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