Raut M, Schein J, Mody S, Grant R, Benson C, Olson W
Ortho-McNeil Janssen Scientific Affairs LLC, Raritan, NJ 08869, USA.
Curr Med Res Opin. 2009 Sep;25(9):2151-7. doi: 10.1185/03007990903102743.
A recent study suggested that levofloxacin significantly reduces the hospital length of stay (LOS), by 0.5 days (p = 0.02), relative to moxifloxacin in patients with community-acquired pneumonia (CAP). The current analysis evaluated the potential economic impact of this half-day reduction in LOS.
A cost model was developed to estimate the impact of a half-day reduction in LOS for CAP hospitalizations in the US. CAP incidence, hospitalization rate, and costs were obtained from published studies in PubMed and from publicly available government sources. The average daily cost of hospitalization was estimated for fixed costs, which comprise 59% of total inpatient costs. Costs from prior years were inflated to 2007 US dollars using the consumer price index. A range of cost savings, calculated using inpatient CAP costs from several studies, was extrapolated to the US CAP population.
Using the Centers for Disease Control National Hospital Discharge estimate of 5.3 days LOS for CAP, and an average cost (2007 $US) of $13,009 per CAP hospitalization, a daily fixed cost of $1448 was estimated. The resultant half-day reduction in costs associated with LOS was $724/hospitalization (range $457 to $846/hospitalization). When fixed and variable costs were considered, the estimated savings were $1227.27/episode. The incidence of CAP was estimated to be 1.9% (5.7 million cases/year based on current population census), and the estimated rate of CAP hospitalization was 19.6% (1.1 million annual hospitalizations). At $13,009/CAP-related hospitalization, total fixed inpatient costs of $8.6 billion annually were projected. The half-day reduction in LOS would therefore generate potential annual savings of approximately $813 million (range $513 million to $950 million). When total costs (fixed plus variable) were estimated, the mean savings for a half-day reduction would be approximately $1227/episode (range of $775 to $1434) or $1.37 billion annually in the US CAP population (range of $871 million to $1.6 billion). Limitations include the use of a single study for the estimation of fixed costs but a diversity of sources used for estimates of other variables, and lack of data with respect to the effects on costs of diagnostic-related groups, discounted contracts, and capitated payments.
A relatively small decrease in LOS in CAP can have a substantial cost impact, with estimated savings of $457 to $846 per episode or $500-$900 million annually. Additional evaluation is warranted for interpreting these cost-savings in the context of current antibiotic prescribing patterns.
最近一项研究表明，对于社区获得性肺炎（CAP）患者，与莫西沙星相比，左氧氟沙星可显著缩短住院时间（LOS）0.5天（p = 0.02）。本分析评估了LOS缩短半天所带来的潜在经济影响。
建立了一个成本模型，以估算美国CAP住院患者LOS缩短半天的影响。CAP发病率、住院率和成本数据来自PubMed上发表的研究以及公开的政府来源。估算了住院固定成本的日均费用，固定成本占住院总费用的59%。使用消费价格指数将前几年的成本换算为2007年美元。根据多项研究中CAP住院成本计算出的一系列成本节约数据，推算出美国CAP患者群体的情况。
根据疾病控制中心对CAP患者LOS为5.3天的全国医院出院估计数，以及每次CAP住院的平均成本（2007年美元）为13,009美元，估算出每日固定成本为1448美元。因此，与LOS相关的成本缩短半天为每次住院724美元（范围为每次住院457至846美元）。考虑固定成本和可变成本时，估计节约为每次发作1227.27美元。CAP发病率估计为1.9%（根据当前人口普查，每年570万例），CAP住院率估计为19.6%（每年110万例住院）。按每次与CAP相关的住院费用13,009美元计算，预计每年住院固定总成本为86亿美元。因此，LOS缩短半天将产生约8.13亿美元的潜在年度节约（范围为5.13亿美元至9.5亿美元）。估算总成本（固定成本加可变成本）时，LOS缩短半天的平均节约约为每次发作1227美元（范围为775至1434美元），在美国CAP患者群体中每年节约13.7亿美元（范围为8.71亿美元至16亿美元）。局限性包括使用单一研究估算固定成本，但其他变量的估算使用了多种来源，并且缺乏关于诊断相关组、折扣合同和按人头付费对成本影响的数据。
CAP患者LOS相对较小的降低可能会产生重大的成本影响，估计每次发作节约457至846美元或每年节约5亿至9亿美元。在当前抗生素处方模式的背景下，有必要进行进一步评估以解释这些成本节约情况。
