JAC Advance Access originally published online on February 29, 2008
Journal of Antimicrobial Chemotherapy 2008 61(5):1162-1168; doi:10.1093/jac/dkn073
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Original research |
Treatment costs associated with community-acquired pneumonia by community level of antimicrobial resistance
1 Pharmacotherapy Outcomes Research Center, Department of Pharmacotherapy, College of Pharmacy, University of Utah, 421 Wakara Way, Suite 208, Salt Lake City, UT 84108, USA 2 Sanofi-Aventis, Health Outcomes Research, 55 Corporate Drive, Mail Code 55C-320-A, Bridgewater, NJ 08807-0977, USA 3 Department of Family and Preventative Medicine, College of Medicine, University of Utah, 375 Chipeta Way Room 201, Salt Lake City, UT 84108, USA 4 Pharmaceutical Health Services Research Department, University of Maryland School of Pharmacy, 220 Arch St, 12th Floor, Baltimore, MD 21201, USA
Received 19 October 2007; returned 4 November 2007; revised 24 January 2008; accepted 1 February 2008
* Corresponding author. Tel: +1-801-587-9715; E-mail: carl.asche{at}pharm.utah.edu
Introduction: The aim is to quantify community-acquired pneumonia (CAP) treatment outcomes and costs from a managed care perspective by the level of macrolide resistance corresponding to the metropolitan statistical area (MSA) where patients lived.
Materials and methods: A retrospective analysis was conducted using the i3 Magnify database (05/2000–05/2005) and the Prospective Resistant Organism Tracking and Epidemiology for the Ketolide Telithromycin (PROTEKT) database. Continuously enrolled patients aged 18 years and older residing in MSAs with PROTEKT data that had an outpatient CAP-related ICD-9 code and with one antibiotic pharmacy claim within 7 days were included. Patients were excluded for having a prior condition or drug treatment that could mimic CAP or precipitate infections, or for recent hospitalizations. Treatment costs by the level of resistance in the patient's MSA, by treatment outcome and by initial treatment were measured and adjusted for differences in baseline patient characteristics.
Results: The final study included 9446 CAP cases (average age of 47.6 years, 52.2% male). The majority (56.1%) resided in an MSA with macrolide resistance rates of <25%. Treatment success rates were 82.5% and 80.5% for MSAs with resistance levels being <25% and 
25%, respectively (P < 0.001). Treatment failure resulting in hospitalization was higher in resistance areas 25% at 13.1% versus 8.0% in areas with resistance <25% (P < 0.001). Average adjusted treatment costs were 33% higher for those treated in areas with resistance levels 25% than for those treated in areas where resistance was <25%. Treatment success was associated with average adjusted costs that were 58% less than those whose initial treatment failed, controlling for level resistance (P < 0.001).
Conclusions: This study observed an association between community-level macrolide resistance and treatment and economic outcomes. Treatment failure costs were higher for CAP patients treated in areas with macrolide resistance rates 25% than for those treated in areas where resistance was 
25%.
Keywords: infectious disease , antibiotics , macrolides , quinolones