[A pharmacoeconomic study of the antibiotic treatment of the acute manifestations of chronic bronchitis in primary care. The DAFNE Group].

OBJECTIVE

To evaluate the effectiveness and the cost of antibiotic treatment of chronic bronchitis (CB) crises and COPD in PC.

DESIGN

Prospective cohort study of patients with CB and COPD monitored in health districts. Information was requested on the first ten patients, without any selection, who attended for consultation with the diagnosis of a crisis in their CB or COPD. They were followed for 30 days and the direct costs of their care were evaluated. The cost-effectiveness of the various types of antibiotic treatment was analysed.

RESULTS

268 doctors took part and provided 2354 patients who were valid for the study. 20.8% (490/2354) came back within 30 days because of poor evolution: 79 (3.3%) of these needed hospital admission. The average cost of the failure was 57,687 pesetas. The cost of the use of cephixime was 14,388 pesetas per crisis, with 82.5% effectiveness. The cost for the alternative of "other antibiotics" was 19,775 pesetas, with 73.4% effectiveness. For the alternative amoxycillin-clavulanic acid, the cost was 18,647 pesetas with 74.4% effectiveness.

CONCLUSIONS

A fifth of the patients evolved poorly, which led to the admission of 3.3%. Cephixime treatment was the dominant treatment, as it is more effective and cheaper than all the other antibiotics and than amoxycillin-clavulanic acid treatment. The cost of the therapeutic failure of crises is more than three times greater than the cost of antibiotic treatment. The rate of failure, which means considerable morbidity at very high cost, must be reduced.