Hospital expenditures in the United States and Canada

THE HIGH COST OF MEDICAL CARE

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Hospital expenditures in the United States and Canada.
Redelmeier DA, et al.
N Engl J Med 1993 Mar 18;328(11):772-8.

The results of this study indicate that hospital costs in the U.S. are considerably higher than in Canada. In 1987, the cost of each patient' admission to an acute care hospital was 24% higher in the U.S. than in Canada, and 46% higher in California than in Ontario. Total hospital expenditures were significantly lower in Canada even though Canadian hospitals had more hospital beds (5.4 vs. 3.9 per 1000 individuals) more admissions (142 vs. 129 per 1000 individuals) and longer stays (11.2 vs. 7.2 days) than U.S hospitals. Higher administrative costs were partly responsible for the increase in hospital expenses observed in the U.S. Applying the same spending patterns of Canada would have saved to the U.S. over $30 billion in 1985 alone.

The cost of inappropriate admissions: a study of health benefits and resource utilization in a department of internal medicine.
Eriksen BO, Kristiansen IS, Nord E, Pape JF, Almdahl SM, Hensrud A, Jaeger S.
J Intern Med 1999 Oct;246(4):379-87.

The results of this study show that approximately 1 every 4 patients are inappropriately admitted to the hospital. The study was conducted on 422 consecutive patients who were admitted to a teaching hospital over a 6-week period. In 102 of them (24%), the admission was judged to be inappropriate. The average cost of each inappropriate admission was estimated at $2532, significantly lower than that of appropriate admissions ($5800). Overall, unnecessary admissions accounted for 12% of the total hospital costs.

The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group.
Bates DW; et al.
JAMA, 277(4):307-11 1997 Jan 22-29.

The results of this study indicate that over a 6-month period, 190 of the 4108 admissions to a tertiary hospital occurred as a consequence of an adverse drug event (ADE). Of these, 60 were preventable. The authors estimated at $5.6 million the annual cost of all admissions for ADEs in a 700-bed teaching hospital, and at $2.8 million the cost of preventable ADEs. These data indicate that ADEs account for a substantial fraction of total hospital costs. Implementation of measures aimed at reducing the occurrence of these events would translate in significant health care savings and in reduction of patients' morbidity and mortality.

Involvement of HMO-based pharmacists in clinical rounds at contract hospitals.
Yee DK; Veal JH; Trinh B; Bauer S; Freeman CH.
Am J Health Syst Pharm, 54(6):670-3 1997 Mar 15.

The results of this study indicate that the recommendations of a managed care pharmacist participating to clinical rounds saved, over a 14-month period, an estimated $523,907 to the hospital. These data indicate that inappropriate drug treatment is an important source of extra health care expenses in hospital settings.

Pharmacist participation on physician rounds and adverse drug events in the intensive care unit.
Leape LL, et al.
JAMA 1999 Jul 21;282(3):267-70.

The results of this study, conducted in the intensive care unit of a teaching hospital, show that participation of a senior pharmacist to clinical rounds decreased the rate of preventable adverse events caused by prescription errors by 66%.

Impact of a pharmacist on medication discontinuation in a hospital-based geriatric clinic.
Phillips SL; Carr-Lopez SM.
Am J Hosp Pharm, 47(5):1075-9 1990 May.

This study evaluated the effect of a pharmacist on doctors' drug prescription practices in a geriatric ambulatory care clinic. Before pharmacist intervention, 72 patients received 414 prescriptions, 246 of which were for drugs associated with adverse drug reactions in the elderly. After intervention, there was a 32% reduction in total number of prescription with a direct overall cost saving of $3872 over a six-month period.

Drug-related emergency department visits and hospital admissions.
Prince BS; Goetz CM; Rihn TL; Olsky M.
Am J Hosp Pharm, 49(7):1696-700 1992 Jul.

The results of this study show that 2.9% of visits to the emergency department of a tertiary care hospital are due to drug-related problems. Twenty-four percent of these visits result in hospital admission, and the average cost of each admission is $8888.

Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality.
Classen DC; Pestotnik SL; Evans RS; Lloyd JF; Burke JP.
JAMA, 277(4):301-6 1997 Jan 22-29.

The results of this study indicate that 2.43% of hospital admissions are complicated by adverse drug events (ADEs). ADEs are associated with a prolonged length of stay of 1.91 days, an increased cost of $2262 per event, and an almost doubled risk of death.

Medication errors: 1977 to 1988. Experience in medical malpractice claims.
Kuehm SL; Doyle MJ.
N J Med, 87(1):27-34 1990 Jan.

This article shows that from 1977 to 1988, MIIENJ paid US$30,144,636 in indemnity from medical malpractice suits due to medication errors.

Pressure ulcers, hospital complications, and disease severity: impact on hospital costs and length of stay.
Allman RM, Goode PS, Burst N, Bartolucci AA, Thomas DR.
Adv Wound Care 1999 Jan-Feb;12(1):22-30.

The results of this study, conducted on a sample population of 286 patients aged 55 and over, show that those who developed pressure ulcers had significantly increased length of hospital stay (21 vs. 13 days) and incidence of hospital-related infections (46% vs. 20%) and other complications (86% vs. 43%), compared to those who did not. Hospital costs for patients with incident pressure ulcers were estimated at $29,048, more than two-fold higher than the costs for patients without this ailment ($13,819).

Sedative-hypnotic use and increased hospital stay and costs in older people.
Zisselman MH, Rovner BW, Yuen EJ, Louis DZ.
J Am Geriatr Soc 1996 Nov;44(11):1371-4.
The results of this study, conducted on a cohort of 856 consecutive elderly patients admitted to a tertiary care teaching hospital, show that those with sedative-hypnotic (S/H) use exceeding the Health Care Financing Administration (HCFA) guidelines had, compared to patients with S/H use within recommended values or not on these drugs, longer hospital stay (21.5 days vs 12.3 days vs 6.7 days), increased hospital costs ($29,245 vs $15,219 vs $7,516), and greater severity of illness. These data indicate that appropriate use of sedative-hypnotic drugs could reduce morbidity and substantially cut health care costs.

Expenditures for psychotropic medications in the United States in 1985.
Zorc JJ. et al.
Am J Psychiatry 1991 May;148(5):644-7.

This study shows that, in 1985, the U.S. spent $1.45 billion in psychotropic drugs for outpatients. Sixty percent of this sum ($868 million) was spent for antianxiety and sedative-hypnotic medications, 18% for antipsychotics, and 17% for antidepressants.

The direct economic costs of insomnia in the United States for 1995.
Walsh JK, Engelhardt CL.
Sleep 1999 May 1;22 Suppl 2:S386-93.

The results of this study show that in 1995, the U.S. spent $13.9 billion for the treatment of insomnia.

Reevaluation of continuous oxygen therapy after initial prescription in patients with chronic obstructive pulmonary disease.
Oba Y, Salzman GA, Willsie SK.
Respir Care 2000 Apr;45(4):401-6.

The results of this study show that lack of reevaluation of the need of home oxygen therapy in patients with chronic obstructive pulmonary disease (COPD) costs the nation an estimated extra $106-$153 million per year. In the study, 57 patients with COPD were prescribed home oxygen therapy. Of the 55 that returned for follow-up, only 19 (35%) were properly evaluated as to the need for continuous oxygen therapy, and in approximately 60% of them, oxygen treatment was discontinued. These data indicate that the majority of patients with COPD assigned to home oxygen therapy are needlessly kept on treatment. The lack of reevaluation of patients' need for oxygen treatment goes against recommended guidelines issued by the Third Oxygen Therapy Consensus Conference, which recommend patients' reassessment within 1 to 3 months after initiation of oxygen therapy. This omission results in unnecessary discomfort for the patient and in an estimated extra health care expenses of $106 to $153 million per year in the U.S. alone.

Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs.
Wolfe MM, et al.
N Engl J Med. 1999 Jun 17;340(24):1888-99. Review.

This article emphasizes that every year in the U.S., at least 103,000 individuals are hospitalized for serious gastrointestinal toxicity from nonsteroidal antiinflammatory drugs (NSAID) use, and an estimated 16,500 will not survive the complication. Based on these estimates, death from gastrointestinal complications of NSAIDs represents the 15th cause of death in the U.S. Unfortunately these figures are conservative since they do not take in account users of over-the-counter NSAIDs. The cost of NSAID gastrointestinal toxicity has been estimated at approximately $15,000 to $20,000 per hospitalization, leading to total annual health care expenses exceeding $2 billion.

Cost of medication-related problems at a university hospital.
Schneider PJ, Gift MG, Lee YP, Rothermich EA, Sill BE.
Am J Health Syst Pharm 1995 Nov 1;52(21):2415-8.

This study estimated at $1.5 million the costs associated with drug-related complications in a medical center hospital during the year 1994.

Cost implications of malpractice and adverse events.
Korin J.
Hosp Formul 1993 Jan;28 Suppl 1:59-61.

This study shows that each year approximately 5% of hospitalized patients develop hospital-acquired infections, for a total annual cost of $10 billion. Over three-quarters of these expenses are due to increased length of hospital stay for intravenous antibiotic therapy.

Notice to Readers: Fourth Decennial International Conference on Nosocomial and Healthcare-Associated Infections.
MMWR, February 25, 2000 / 49(07);138.

This article reports that every year in the U.S., approximately 2,000,000 patients develop hospital-acquired infections and 88,000 die from them. The cost of hospital-acquired infections has been estimated at $4.6 billion. These estimates are conservative, since they do not take into account infections occurring in patients in nursing homes, outpatient clinics, dialysis centers and other health care centers.

Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention.
Jarvis WR.
Infect Control Hosp Epidemiol, 17(8):552-7 1996 Aug.

The results of this study indicate that every year in the U.S., approximately 2 million patients develop hospital-acquired infections (HAIs). Overall, 23.8 % to 50% of patients with hospital-acquired bloodstream infections and 14.8% to 71% of patients with hospital-acquired pneumonia die. The cost associated with each HAI is: $558 to $593 for each urinary tract infection, $2,734 for each surgical site infection, $3,061 to $40,000 for each bloodstream infection, and $4,947 for each pneumonia.

Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality.
Pittet D, Tarara D, Wenzel RP.
JAMA 1994 May 25;271(20):1598-601.

The results of this study show that the incidence of hospital-related bloodstream infections in the Surgical Intensive Care Unit (SICU) of a tertiary hospital is 2.67%. Mortality rates in patients with this complication are 50% versus 15% in matched controls. Length of stay in the hospital and in the SICU increases significantly in patients with bloodstream infection compared to controls (54 vs. 30 days and 15 days vs. 7 days, respectively). The cost attributable to this complication was estimated at approximately $40,000 per survivor.

Prolongation of hospital stay and extra costs due to hospital-acquired infection in a neonatal unit.
Leroyer A, et al.
J Hosp Infect 1997 Jan;35(1):37-45.

The results of this study indicate that the incidence of hospital-acquired infections (HAIs) in a neonatology unit ias 5.5%. For each HAI, the mean extra length of stay per patient is 5.2 days and the mean extra cost per patient $10,440.

Costs of treating simple nosocomial urinary tract infection.
Rutledge KA, McDonald HP Jr.
Urology 1985 Jul;26(1 Suppl):24-6.

The results of this study show that the annual national cost of hospital-acquired urinary tract infections is $1.8 billion (1985 values).

Infections in the hospitalized elderly.
Gingrich D.
Hosp Physician 1990 Jan;26(1):35-8.
The results of this study show that hospital-acquired infections in the elderly are associated with high mortality rates and with health care costs of $4 billion per year (1990 values).

Otitis media-related antibiotic prescribing patterns, outcomes, and expenditures in a pediatric medicaid population
Berman S; Byrns PJ; Bondy J; Smith PJ; Lezotte D.
Pediatrics, 100(4):585-92 1997 Oct.

This study evaluated the pattern of antibiotic prescribing in a sample population of 12,381 children with middle ear infection. This condition is the most frequent reason for prescribing antibiotics to children in the U.S., even though several studies have shown that they are no better than placebo in the management of children and infants with middle ear infections. The results of the study show that in 1991 and 1992, low-cost antibiotics accounted for 67% of the total antibiotic fills and for 21% of the total costs. High-cost antibiotics, on the other hand, accounted for 30% of the fills and for 77% of the total costs. The more expensive antibiotics had the same efficacy and were associated with a slightly higher incidence of adverse reactions compared to the less expensive ones. These data indicate that just switching choice of antibiotic in patients with middle ear infection could save almost two-thirds of the cost of antibiotic treatment without interfering with patient outcome.

Errors in the treatment of tuberculosis in Baltimore.
Rao SN, Mookerjee AL, Obasanjo OO, Chaisson RE.
Chest 2000 Mar;117(3):734-7.

The results of this study show that private physicians often treat tuberculosis (TB) incorrectly, favoring the development of acquired drug resistance and multidrug resistant TB. The study was conducted on 110 patients diagnosed with TB in the city of Baltimore between 1994 and 1995. Almost 40% of patients treated by a private physician were prescribed the wrong treatment regimen, compared to 5% of those treated at the Baltimore City Health Department's Tuberculosis Clinic. Inappropriate management consisting of low-doses antibiotics and short treatment courses is an important cause of treatment failure and acquired antibiotic resistance. The authors estimated the costs of salvage of inadequate treatment at $180,000 per patient.

"Routine" preoperative studies. Which studies in which patients?
Marcello PW, Roberts PL.
Surg Clin North Am 1996 Feb;76(1):11-23

This article highlights that 60% of routine tests conducted on patients in preparation of their surgery are unnecessary and add an extra $18 billion to the annual health care bill. In addition, unnecessary tests cause harm resulting from complications associated with the testing procedure, or with the unnecessary treatment of patients who receive a false positive test result.

Unnecessary preoperative investigations: evaluation and cost analysis.
Allison JG; Bromley HR.
Am Surg, 62(8):686-9 1996 Aug.

The results of this study indicate that two-thirds of the tests patients undergo in preparation of their surgery are unnecessary. The study evaluated prospectively the appropriateness of pre-operative testing in 60 randomly selected ambulatory surgery patients. Only one-third of tests had clinical indications and was therefore deemed appropriate. The cost of inappropriate tests was estimated at $47 to $80 per patient. The authors emphasize the need of changing obsolete practices.

Extraimmunization Among US Children.
Feikema SM et al.
JAMA 2000;283:1311-1317.

The results of this study show that in the U.S., every year approximately 900,000 children aged 19-36 months (one fifth of all U.S. children in that age group) receive at least an extra immunization, leading to an excess cost of $26.5 billion. The investigators surveyed parents of 32,742 children and obtained information from 22,806 of them through their health care provider. They found that 21% of them had received at least one extra vaccination. Extra doses of vaccine, in addition to adding discomfort and stress to the baby, are associated with an increased risk of adverse reactions. The risk of adverse reactions is particularly high with extra doses of the diphtheria-tetanus vaccine, and there is evidence showing that extra doses of these vaccines can cause serious side effects. In addition extra immunizations add extra costs and labor to the health care system. This study estimated this excess cost at $26.5 billions. This estimate, however, is conservative, since it does not take in account the costs associated with vaccine handling and distribution, parent's travel time, treatment for adverse effects, or other indirect costs.

Cost-Utility Analysis of Screening Intervals for Diabetic Retinopathy in Patients With Type 2 Diabetes Mellitus.
Vijan S; Hofer TP; Hayward RA.
JAMA 2000;283:889-896.
The results of this study show that screening for eye disease every other year or every three years can be as effective as screening annually to prevent blindness in patients with type 2 diabetes and no signs of eye deterioration. Current guidelines recommend yearly eye examination for diabetic patients on the basis of cost-effectiveness analyses demonstrating an economic benefit associated with this practice. The authors of the study used a computer model to assess the costs and effectiveness of yearly versus extended screening intervals. The results of the study indicate that a high-risk diabetic patient aged 45 years with poor glycemic control is expected to gain 21 days of sight by attending screening visits annually, rather than every third year. On the other hand, a 65-year old low-risk diabetic patient with moderately well glycemic control is expected to gain 3 days of sight by undergoing screening annually, rather than every third year. Screening low-risk patients annually rather than every other year results in an additional cost of $123,580 for each year of quality life gained. These estimates show that annual eye screening produces little benefits in low-risk diabetic patients, while substantially increasing health care costs. The authors emphasize that current guidelines calling for yearly screening in patients with type 2 diabetes should be re-evaluated, and recommendations should be tailored to patients clinical status.

Costs of poison-related hospitalizations at an urban teaching hospital for children.
Woolf A; Wieler J; Greenes D.
Arch Pediatr Adolesc Med, 151(7):719-23 1997 Jul.

The results of this study show that poison-related admissions to a single pediatric facility account for 0.9% of all pediatric hospital admissions and are associated with an estimated annual cost of $1 million. Acetaminophen, lead and antidepressants are the substances most frequently involved in poisoning.

Economic outcomes of a targeted intervention program: the costs of treating allergic rhinitis patients.
Santos R, Cifaldi M, Gregory C, Seitz P.
Am J Manag Care 1999 Apr;5(4 Suppl):S225-34.

The results of this study, conducted on a cohort of 7,936 patients with symptoms of allergic rhinitis, show that each year one managed care provider (Lovelace Health Systems) spends approximately $2 million for the symptomatic treatment of this condition.

Cost effectiveness of low-molecular weight heparin versus warfarin following hip replacement surgery.
Saunders ME; Grant RE.
J Natl Med Assoc, 90(11):677-80 1998 Nov.

This study compared the cost-efficacy of low-molecular-weight (LMW) heparin versus warfarin use for the prophylaxis of deep vein thrombosis and pulmonary embolism following hip-replacement surgery. Use of LMW heparin was associated with a saving of $1,253 per patient and with a 0% versus 3% incidence of thrombo-embolic events, compared to warfarin. These data indicate that switching to LMW heparin could significantly cut health care costs and improve patient outcome.

Cost-effectiveness of routine radiation therapy following conservative surgery for early-stage breast cancer.
Hayman JA; Hillner BE; Harris JR; Weeks JC.
J Clin Oncol, 16(3):1022-9 1998 Mar.

The results of this study show that in women aged 60 and older, radiation therapy after conservative surgery for early stage breast cancer adds nothing in terms of life expectancy while increasing the cost of therapy by $9,800 per patient.

Escalating costs for cancer chemotherapy.
Nyman JV; Dorr RT; Hall GR.
Am J Hosp Pharm, 38(8):1151-4 1981 Aug.

The results of this study indicate that the annual cost of antineoplastic drugs for one hospital rose from $10,156 in 1973-1974 to $296,914 in 1979-1980, these amounts consisting of 5.74% and 16.74% of the hospital total drug budget, respectively. This increase was not justified by patient load, inflation, or amount of medication prescribed.

The costs of cancer care in the United States: implications for action.
Schuette HL; Tucker TC; Brown ML; Potosky AL; Samuel T.
Oncology (Huntingt), 9(11 Suppl):19-22 1995 Nov.

This article emphasizes that the annual direct and indirect costs of cancer care are in the range of $100 billion, indicating the need to shift the costs toward more effective measures such as prevention.

Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial.
Naylor MD, Brooten D, Campbell R, Jacobsen BS, Mezey MD, Pauly MV, Schwartz JS.
JAMA 1999 Feb 17;281(7):613-20.

This randomized study evaluated the outcome of a comprehensive discharge planning and home follow-up intervention program conducted by nurses from two urban hospitals on a cohort of elderly patients at risk for hospital readmissions. Twenty-four weeks after discharge, patients in the intervention group, compared to those in the control group, showed decreased rate of hospital admissions (37% vs. 20%), decreased rate of multiple hospital readmissions (6.2% vs. 14.5%) and reduced length of hospital stay when re-admitted (1.5 days vs. 4 days). Total Medicare reimbursement costs were about $0.6 million in the intervention group versus $1.2 million in the control group. These data indicate that preventive intervention in high-risk patients results in a 50% reduction in health care costs and in improved patient outcome.

Cost-effectiveness of colon cancer screening.
Lieberman D.
Am J Gastroenterol, 86(12):1789-94 1991 Dec.

This study evaluated the cost-effectiveness of two different methods of colon cancer screening: sigmoidoscopy from age 50 with yearly testing for fecal occult blood (as recommended by the American Cancer Society) and colonoscopy. The cost of preventing one death from colon cancer was estimated to be $444,133 with sigmoidoscopy and $347,214 with colonoscopy.

Clinical and economic impact of oral ciprofloxacin as follow-up to parenteral antibiotics.
Grasela TH Jr; et al.
DICP, 25(7-8):857-62 1991 Jul-Aug.

This study, conducted on a sample population of 766 patients initially treated with parenteral antibiotics for respiratory tract (RTI), skin or skin structure (SSS), bone or joint (BJI), and urinary tract infections (UTI) for a median of 4, 6, 6, and 7.5 days, respectively, shows that switching to oral antibiotic therapy shortened hospital stay and saved in drugs and hospitalization costs a total of $980,246.

Cost and morbidity associated with antibiotic prophylaxis in the ICU.
Namias N; Harvill S; Ball S; McKenney MG; Salomone JP; Civetta JM.
J Am Coll Surg, 188(3):225-30 1999 Mar.

This study evaluated prospectively data on prophylactic antibiotic (PA) treatment in patients admitted to the Surgical Intensive Care Unit of a teaching hospital over a 19-month period, to determine physicians' compliance to current guidelines recommending cessation of PA at 24 hours. In 61% of patients, PA therapy was continued beyond 24 hours. Patients receiving PA for more than 4 days had higher rates of bacteremias and line infections, compared to those with shorter antibiotic course. The cost of inappropriate antibiotic treatment in this patient population was estimated at $44,893.

Antimicrobial prophylaxis in surgical patients.
Crossley K, Gardner LC.
JAMA 1981 Feb 20;245(7):722-6.

This study evaluated use of prophylactic antibiotics (PA) in a cohort of 1,021 surgical patients from 27 different hospitals. Only 41% of patients received PA in the four hours before surgery, and in one-third of patients PA continued for more than 72 hours. Reducing the time of PA treatment would save 18% to 50% of the total cost of perioperative antibiotic prophylaxis.

Surveillance of the use of antibiotic prophylaxis in surgery.
Finkelstein R, Reinhertz G, Embom A.
Isr J Med Sci 1996 Nov;32(11):1093-7.

This study evaluated implementation of prophylactic antibiotic (PA) treatment two years after updated recommendations on its use were made available throughout the surgical wards of an Israeli hospital. In certain types of surgery, PA was prescribed systematically without indications for its use. In almost 50% of patients the first dose of PA therapy was not given at the appropriate timing; PA administration extended over the recommended 24 hours in 21% of cases and frequently consisted of unstandardized regimens. These data indicate high rates of inappropriate PA treatment. This phenomenon results in extra health care costs and contributes to the worldwide increase in antibiotic resistance.

Surgical infections and prophylactic antibiotics: 341 consecutive cases of gallbladder surgery in the era of laparoscopic surgery.
Garcia N, Kapur S, McClane J, Davis JM.
J Laparoendosc Adv Surg Tech A 1997 Jun;7(3):157-62.

This study evaluated the appropriateness of prophylactic antibiotic (PA) treatment in a cohort of 341 consecutive patients admitted to the hospital for laparoscopic and open cholecystectomy. In 63.2% of cases PA was administered inappropriately. Seventy-three percent of patients received a large-spectrum antibiotic when a cheaper and narrower spectrum agent would have been adequate.

Oral versus intravenous antibiotics for community acquired lower respiratory tract infection in a general hospital: open, randomised controlled trial.
Chan R; Hemeryck L; O'Regan M; Clancy L; Feely J.
BMJ, 310(6991):1360-2 1995 May 27.

The results of this study, conducted on a cohort of 541 patients admitted to the hospital over a 1-year period for lower respiratory tract infections who had no immune system depression or severe infection, show that treatment with oral antibiotics is equally effective to intravenous antibiotic therapy as to patient clinical outcome and mortality, and is associated with reduced hospital length of stay. The authors estimated that if the 800 patients admitted every year to the hospital would be treated routinely with oral rather than intravenous antibiotics, the hospital could save approximately 176,000 pounds per year, and patients would benefit from early discharge.

Early transition to oral antibiotic therapy for community-acquired pneumonia: duration of therapy, clinical outcomes, and cost analysis.
Omidvari K; de Boisblanc BP; Karam G; Nelson S; Haponik E; Summer W.
Respir Med, 92(8):1032-9 1998 Aug.

This randomized study evaluated the therapeutic efficacy and costs of conventional 7-day treatment with intravenous (IV) antibiotics for community-acquired pneumonia versus abbreviated 2-day course of IV antibiotics followed by oral antibiotics. Clinical course, cure rates and survival were similar in the two treatment groups. Oral therapy was associated with shorter hospital stay (7.3 versus 9.71 days) and reduced overall costs of care ($2953 vs. $5002 per patient).

Oral versus initial intravenous therapy for urinary tract infections in young febrile children.
Hoberman A, Wald ER, Hickey RW, Baskin M, Charron M, Majd M, et al.
Pediatrics 1999 Jul;104(1 Pt 1):79-86.

This randomized study evaluated the cost and efficacy of outpatient oral versus inpatient intravenous antibiotic therapy in the treatment of children 1 to 24 months old with febrile urinary tract infection. Oral therapy was judged to be as safe and effective as intravenous therapy, and its use was associated with an over 50% reduction in overall costs ($1473 per patient for oral therapy versus $3577 for intravenous therapy).

The cost of antibiotics in treating upper respiratory tract infections in a medicaid population.
Mainous AG 3rd; Hueston WJ.
Arch Fam Med, 7(1):45-9 1998 Jan-Feb.

Antibiotic therapy for nonspecific upper respiratory tract infections (URIs) is nonindicated and ineffective, and increases the occurrence of antibiotic-resistant pathogens. This study evaluated antibiotic prescribing practices for URIs in a sample population of 50,000 Medicaid recipients. Antibiotics were prescribed in 60% of outpatient visits and in 48% of emergency department episodes. In 23% and 9% of the outpatient and emergency department visits, respectively, a prescription for antihistamines was filled. These data indicate that contrary to published guidelines, physicians routinely prescribe antibiotics in over 50% of patients with upper respiratory infections, resulting in significant extra health care costs and in the favoring of the spread of antibiotic-resistant bacterial strains.

Antibiotic administration in patients undergoing common surgical procedures in a community teaching hospital: the chaos continues.
Gorecki P, Schein M, Rucinski JC, Wise L.
World J Surg. 1999 May;23(5):429-32.

This study evaluated the appropriateness of antibiotic treatment in a randomly selected sample of 211 patients undergoing elective (132 patients) or emergency (79 patients) surgery in a teaching hospital during 1996. Seventy-four percent of patients received inappropriate antibiotic treatment. The total cost of prolonged antibiotic treatment for this cohort was estimated at $18,533.

Decrease in expenditures and selected nosocomial infections following implementation of an antimicrobial-prescribing improvement program.
Frank MO, Batteiger BE, Sorensen SJ, Hartstein AI, Carr JA, McComb JS, et al.
Clin Perform Qual Health Care 1997 Oct-Dec;5(4):180-8

The results of this study show that implementation of an antimicrobial-prescribing improvement program in an academic medical center was associated with a substantial reduction in antibiotic use, which translated in cost savings of $390,000 in 1994 alone, compared to the costs prior to program implementation. In addition, decreased use of antimicrobial agents was associated with an over 50% reduction in the rate of several hospital-acquired infections.

Government orders inquiry as price of generic drugs soars.
Jones, J.
BMJ 1999;319:1151 ( 30 October ).

This article reports on the recent sharp increase in the price of generic drugs in UK. In 1999 for example, the price of common drugs such as amoxicillin, furosemide, and thyroxine, was 4-8 times higher than in 1998. This rise could result in extra annual health care expenses of $320 million.

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