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Cost effectiveness of adherence to IDSA/ATS guidelines in elderly patients hospitalized for Community-Aquired Pneumonia
- Source :
- BMC Medical Informatics and Decision Making
- Publication Year :
- 2015
-
Abstract
- Background Adherence to guidelines for the treatment of hospitalized elderly patients with community-acquired pneumonia (CAP) has been associated with improved clinical outcomes. This study evaluated the cost-effectiveness of adherence to guidelines for the treatment of CAP in an elderly hospitalized patient cohort. Methods Data from an international, multicenter observational study for patients age 65 years or older hospitalized with CAP from 2001 to 2007 were used to estimate transition probabilities for a multi-state Markov model traversing multiple health states during hospitalization for CAP. Empiric antibiotic therapy was classified as adherent, over-treated, and under-treated according to 2007 Infectious Disease Society of America/American Thoracic Society IDSA/ATS guidelines. Utilities were estimated from an expert panel of active clinicians. Costs were estimated from a tertiary referral hospital and adjusted for inflation to 2013 US dollars. Costs, utilities, and transition probabilities were all modeled using probability distributions to handle their inherit uncertainty. Cost-effectiveness analysis was based on the first 14 days of hospitalization. Patients admitted to the intensive care unit (ICU) were analyzed separately from those admitted to the ward. Sensitivity analyses with regards to time frame (out to 30 days hospitalization), cost estimates, and willingness to pay values were performed. Results The model parameters were estimated using data from 1635 patients (1438 admitted to the ward and 197 admitted to the ICU). For the ward model, adherence to antibiotic guidelines was the dominant strategy and associated with lower costs (−$1379 and −$799) and improved quality of life compared to over- and under-treatment. In the ICU model, however, adherence to guidelines was associated with greater costs (+$13,854 and + $3461 vs. over- and under-treatment, respectively) and lower quality of life. Acceptance rates across the willingness to pay ranges evaluated were 42–48 % for guideline adherence on the ward and 61–64 % for over-treatment on the ICU. Results were robust over sensitivity analyses concerning cost and utility estimates. Conclusions While adherence to antibiotic guidelines was the most cost-effective strategy for elderly patients hospitalized with CAP and admitted to the ward, in the ICU over-treatment of patients relative to the guidelines was the most cost-effective strategy. Electronic supplementary material The online version of this article (doi:10.1186/s12911-016-0270-y) contains supplementary material, which is available to authorized users.
- Subjects :
- Male
medicine.medical_specialty
Pediatrics
Cost effectiveness
Cost-Benefit Analysis
Health Informatics
030204 cardiovascular system & hematology
Tertiary referral hospital
law.invention
03 medical and health sciences
0302 clinical medicine
Community-acquired pneumonia
Quality of life
law
Outcome Assessment, Health Care
medicine
Time to clinical stability
Humans
030212 general & internal medicine
Hospital Mortality
Costeffectiveness
Aged
Retrospective Studies
Aged, 80 and over
business.industry
Health Policy
Retrospective cohort study
Multi-state model
Length of Stay
medicine.disease
Intensive care unit
Length of hospital stay
Markov model
Computer Science Applications
Community acquired pneumonia
Community-Acquired Infections
In-hospital mortality
Cohort
Emergency medicine
Observational study
Female
Guideline Adherence
business
Research Article
Subjects
Details
- ISSN :
- 14726947
- Volume :
- 16
- Database :
- OpenAIRE
- Journal :
- BMC medical informatics and decision making
- Accession number :
- edsair.doi.dedup.....9c02ccb27ee179afccacdac4c3746fea