Original Articles
Risk Factors for Increased Cost of Exacerbations of Chronic Bronchitis and Chronic Obstructive Pulmonary Disease
C. Llora, K. Naberanb, J.M. Cotsa, J. Molinac, F. Rosd, M. Miravitllese,
, on behalf of the EFEMAP *
Corresponding author
marcm@clinic.ub.es
Correspondence: Dr. M. Miravitlles. Servicio de Neumología. Institut Clínic del Tòrax. Hospital Clínic. Villarroel, 170 (UVIR, escalera 2, planta 3). 08036 Barcelona. España
Correspondence: Dr. M. Miravitlles. Servicio de Neumología. Institut Clínic del Tòrax. Hospital Clínic. Villarroel, 170 (UVIR, escalera 2, planta 3). 08036 Barcelona. España
a Infectious Diseases Group of the Catalan Society of Family Medicine
b Pulmonology Group of the Catalan Society of Family Medicine
c Primary Care Respiratory Group (GRAP)
d Departamento Médico BayerHealthcare BayerHealthcare, Barcelona, Spain
e Servicio de Neumología, Institut Clínic del Tòrax (IDIBAPS), Member of the Red Respira RTIC 03/11 ISCIII, Hospital Clínic, Barcelona, Spain
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"apellidos" => "Llor" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 1 => array:3 [ "nombre" => "K." "apellidos" => "Naberan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 2 => array:3 [ "nombre" => "J.M." "apellidos" => "Cots" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Molina" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] ] 4 => array:3 [ "nombre" => "F." "apellidos" => "Ros" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff4" ] ] ] 5 => array:5 [ "preGrado" => "Dr." "nombre" => "M." "apellidos" => "Miravitlles" "email" => array:1 [ 0 => "marcm@clinic.ub.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff5" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 6 => array:2 [ "colaborador" => "on behalf of the EFEMAP" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "fn1" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Infectious Diseases Group of the Catalan Society of Family Medicine" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Pulmonology Group of the Catalan Society of Family Medicine" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Primary Care Respiratory Group (GRAP)" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] 3 => array:3 [ "entidad" => "Departamento Médico BayerHealthcare BayerHealthcare, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff4" ] 4 => array:3 [ "entidad" => "Servicio de Neumología, Institut Clínic del Tòrax (IDIBAPS), Member of the Red Respira RTIC 03/11 ISCIII, Hospital Clínic, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff5" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence: Dr. M. Miravitlles. Servicio de Neumología. Institut Clínic del Tòrax. Hospital Clínic. Villarroel, 170 (UVIR, escalera 2, planta 3). 08036 Barcelona. España" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-02-22" "fechaAceptado" => "2005-10-29" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec154309" "palabras" => array:6 [ 0 => "Chronic bronchitis" 1 => "COPD" 2 => "Exacerbations" 3 => "Antibiotics" 4 => "Costs" 5 => "Pharmacoeconomics" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec154308" "palabras" => array:6 [ 0 => "Bronquitis crónica" 1 => "EPOC" 2 => "Agudizaciones" 3 => "Antibióticos" 4 => "Costes" 5 => "Farmacoeconomía" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">TO identify what variables characterizing the patients, exacerbations, and treatment of chronic bronchitis and chronic obstructive pulmonary disease (COPD) are associated with a higher direct health cost.</p> <span class="elsevierStyleSectionTitle">Method</span><p class="elsevierStyleSimplePara elsevierViewall">Observational pharmacoeconomic study of exacerbations of chronic bronchitis and COPD (of probable bacterial etiology, defined as Anthonisen types I or II). Direct health costs were assessed during 30 days of follow-up. Logistic regression was employed for statistical analysis, with calculation of the adjusted odds ratios (OR). An exacerbation cost greater than €150 was defined as the dependent variable.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">Data on 1164 patients were collected by 252 physicians. Pharmacoeconomic data were complete in 947 patients (82.6%). In the first 30 days, 206 sought medical attention because of unsatisfactory response to treatment (21.8%), 69 (7.3%) attended the emergency room, and 22 (2.3%) were admitted to hospital. Overall, 101 exacerbations (10.7%) were classified as high cost (>€150). Continuous oxygen therapy (OR=7.58) and previous hospitalization (OR=2.6) were associated with high-cost exacerbations, whereas diagnosis of chronic bronchitis (OR=0.41) and treatment of the exacerbation with moxifloxacin or amoxicillin—clavulanic acid as opposed to clarithromycin (OR=0.38) were associated with low-cost exacerbations.</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p class="elsevierStyleSimplePara elsevierViewall">Treatment failure was reported for 21.8% of the patients with exacerbations of chronic bronchitis and COPD. Repeated medical visits and requests for complementary tests were the main factors responsible for increased cost. Variables associated with high-cost exacerbations were continuous oxygen therapy, previous hospitalization, and treatment with clarithromycin as opposed to moxifloxacin or amoxicillin-clavulanic acid.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Identificar las variables de los pacientes, de las agudizaciones y del tratamiento de la bronquitis crónica (BC) y la enfermedad pulmonar obstructiva crónica (EPOC) que se asocian con un mayor coste sanitario directo.</p> <span class="elsevierStyleSectionTitle">Método</span><p class="elsevierStyleSimplePara elsevierViewall">Estudio observacional y farmacoeconómico en pacientes con BC y EPOC con agudización de probable etiología bacteriana, definida por presentar 2 o más de los criterios de Anthonisen. Se siguió a los pacientes durante 30 días y se evaluaron los costes directos derivados de su atención. El análisis estadístico se efectuó mediante regresión logística con cálculo de las <span class="elsevierStyleItalic">odds ratio</span> (OR) ajustadas, considerando variable dependiente un coste de agudización superior a los 150 €.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Participaron 252 médicos que recabaron información sobre 1.164 pacientes. Se recogieron todos los parámetros farmacoeconómicos en 947 pacientes (82,6%). En los primeros 30 días, 206 acudieron por mala evolución (21,8%), 69 (7,3%) requirieron atención en urgencias y 22 (2,3%) precisaron ingreso. Se clasificaron como de coste elevado (> 150 €) 101 agudizaciones (10,7%). Las variables que se asociaron a un coste elevado fueron la oxigenoterapia continua (OR = 7,58) y la hospitalización previa (OR = 2,6), mientras que el diagnóstico de BC (OR = 0,41) y el tratamiento de la agudización con moxifloxacino o amoxicilina—ácido clavulánico, comparado con claritromicina (OR = 0,38), se asociaron a un coste bajo.</p> <span class="elsevierStyleSectionTitle">Conclusión</span><p class="elsevierStyleSimplePara elsevierViewall">Un 21,8% de los pacientes con agudización de la BC y EPOC fracasa, con lo que se genera un coste mayor, fundamentalmente por nuevas visitas médicas y solicitud de pruebas complementarias. Las variables que se asocian a una agudización de coste elevado son la oxigenoterapia continua, la hospitalización previa y el tratamiento con claritromicina comparada con moxifloxacino o amoxicilinaácido clavulánico.</p>" ] ] "NotaPie" => array:2 [ 0 => array:1 [ "nota" => "<p class="elsevierStyleNotepara">The EFEMAP was funded by Bayer España.</p>" ] 1 => array:2 [ "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara">The list of investigators who participated in the EFEMAP is included in the Appendix.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Geographical variations in prevalence and underdiagnosis of COPD. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 2 | 4 |
| 2024 October | 26 | 11 | 37 |
| 2024 September | 30 | 15 | 45 |
| 2024 August | 38 | 27 | 65 |
| 2024 July | 26 | 22 | 48 |
| 2024 June | 31 | 18 | 49 |
| 2024 May | 29 | 30 | 59 |
| 2024 April | 19 | 17 | 36 |
| 2024 March | 16 | 13 | 29 |
| 2024 February | 20 | 16 | 36 |
| 2023 March | 2 | 5 | 7 |
| 2023 February | 13 | 18 | 31 |
| 2023 January | 14 | 25 | 39 |
| 2022 December | 20 | 28 | 48 |
| 2022 November | 14 | 18 | 32 |
| 2022 October | 20 | 28 | 48 |
| 2022 September | 14 | 24 | 38 |
| 2022 August | 15 | 32 | 47 |
| 2022 July | 21 | 37 | 58 |
| 2022 June | 17 | 30 | 47 |
| 2022 May | 16 | 30 | 46 |
| 2022 April | 21 | 33 | 54 |
| 2022 March | 15 | 33 | 48 |
| 2022 February | 19 | 30 | 49 |
| 2022 January | 16 | 28 | 44 |
| 2021 December | 15 | 48 | 63 |
| 2021 November | 20 | 64 | 84 |
| 2021 October | 25 | 46 | 71 |
| 2021 September | 17 | 49 | 66 |
| 2021 August | 10 | 26 | 36 |
| 2021 July | 14 | 30 | 44 |
| 2021 June | 12 | 35 | 47 |
| 2021 May | 13 | 22 | 35 |
| 2021 April | 21 | 60 | 81 |
| 2021 March | 19 | 25 | 44 |
| 2021 February | 8 | 19 | 27 |
| 2021 January | 2 | 18 | 20 |
| 2020 December | 9 | 17 | 26 |
| 2020 November | 8 | 11 | 19 |
| 2020 October | 5 | 11 | 16 |
| 2020 September | 12 | 11 | 23 |
| 2020 August | 13 | 16 | 29 |
| 2020 July | 25 | 16 | 41 |
| 2020 June | 29 | 15 | 44 |
| 2020 May | 17 | 21 | 38 |
| 2020 April | 20 | 14 | 34 |
| 2020 March | 16 | 12 | 28 |
| 2020 February | 20 | 20 | 40 |
| 2020 January | 18 | 22 | 40 |
| 2019 December | 13 | 18 | 31 |
| 2019 November | 16 | 17 | 33 |
| 2019 October | 5 | 6 | 11 |
| 2019 September | 2 | 23 | 25 |
| 2019 August | 9 | 10 | 19 |
| 2019 July | 12 | 19 | 31 |
| 2019 June | 4 | 12 | 16 |
| 2019 May | 6 | 11 | 17 |
| 2019 April | 9 | 27 | 36 |
| 2019 March | 6 | 25 | 31 |
| 2019 February | 6 | 13 | 19 |
| 2019 January | 4 | 13 | 17 |
| 2018 December | 4 | 14 | 18 |
| 2018 November | 19 | 12 | 31 |
| 2018 October | 19 | 14 | 33 |
| 2018 September | 18 | 14 | 32 |
| 2018 May | 5 | 0 | 5 |
| 2018 April | 13 | 8 | 21 |
| 2018 March | 5 | 1 | 6 |
| 2018 February | 6 | 5 | 11 |
| 2018 January | 7 | 6 | 13 |
| 2017 December | 3 | 5 | 8 |
| 2017 November | 8 | 7 | 15 |
| 2017 October | 3 | 9 | 12 |
| 2017 September | 2 | 4 | 6 |
| 2017 August | 5 | 10 | 15 |
| 2017 July | 2 | 7 | 9 |
| 2017 June | 6 | 15 | 21 |
| 2017 May | 5 | 8 | 13 |
| 2017 April | 3 | 9 | 12 |
| 2017 March | 4 | 7 | 11 |
| 2017 February | 1 | 2 | 3 |
| 2017 January | 2 | 2 | 4 |
| 2016 December | 8 | 9 | 17 |
| 2016 November | 15 | 6 | 21 |
| 2016 October | 28 | 15 | 43 |
| 2016 September | 9 | 13 | 22 |
| 2016 August | 6 | 6 | 12 |
| 2016 July | 9 | 5 | 14 |
| 2016 March | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 48 | 16 | 64 |
| 2015 September | 57 | 18 | 75 |
| 2015 August | 62 | 15 | 77 |
| 2015 July | 54 | 12 | 66 |
| 2015 June | 46 | 8 | 54 |
| 2015 May | 84 | 15 | 99 |
| 2015 April | 55 | 17 | 72 |
| 2015 March | 56 | 15 | 71 |
| 2015 February | 48 | 10 | 58 |
| 2015 January | 52 | 7 | 59 |
| 2014 December | 61 | 10 | 71 |
| 2014 November | 76 | 9 | 85 |
| 2014 October | 96 | 10 | 106 |
| 2014 September | 81 | 8 | 89 |
| 2014 August | 62 | 8 | 70 |
| 2014 July | 72 | 12 | 84 |
| 2014 June | 73 | 4 | 77 |
| 2014 May | 72 | 13 | 85 |
| 2014 April | 73 | 5 | 78 |
| 2014 March | 65 | 12 | 77 |
| 2014 February | 55 | 5 | 60 |
| 2014 January | 47 | 12 | 59 |
| 2013 December | 45 | 3 | 48 |
| 2013 November | 45 | 10 | 55 |
| 2013 October | 47 | 14 | 61 |
| 2013 September | 42 | 4 | 46 |
| 2013 August | 51 | 12 | 63 |
| 2013 July | 50 | 15 | 65 |
| 2013 June | 57 | 10 | 67 |
| 2013 May | 45 | 8 | 53 |
| 2013 April | 23 | 7 | 30 |
| 2013 March | 11 | 1 | 12 |
Show all
