ABSTRACT
BACKGROUND: Knowing the cost of hospitalizations for exacerbation in bronchiectasis patients is essential to perform cost-effectiveness studies of treatments that aim to reduce exacerbations in these patients. OBJECTIVES: To find out the mean cost of hospitalizations due to exacerbations in bronchiectasis patients, and to identify factors associated with higher costs. METHODS: Prospective, observational, multicenter study in adult bronchiectasis patients hospitalized due to exacerbation. All expenses from the patients' arrival at hospital to their discharge were calculated: diagnostic tests, treatments, transferals, home hospitalization, admission to convalescence centers, and hospitals' structural costs for each patient (each hospital's tariff for emergencies and 70% of the price of a bed for each day in a hospital ward). RESULTS: A total of 222 patients (52.7% men, mean age 71.8 years) admitted to 29 hospitals were included. Adding together all the expenses, the mean cost of the hospitalization was EUR 5,284.7, most of which correspond to the hospital ward (86.9%), and particularly to the hospitals' structural costs. The adjusted multivariate analysis showed that chronic bronchial infection by Pseudomonas aeruginosa, days spent in the hospital, and completing the treatment with home hospitalization were factors independently associated with a higher overall cost of the hospitalization. CONCLUSIONS: The mean cost of a hospitalization due to bronchiectasis exacerbation obtained from the individual data of each episode is higher than the cost per process calculated by the health authorities. The most determining factor of a higher cost is chronic bronchial infection due to P. aeruginosa, which leads to a longer hospital stay and the use of home hospitalization.
Subject(s)
Bronchiectasis/economics , Hospitalization/economics , Adult , Aged , Aged, 80 and over , Disease Progression , Female , Hospital Costs , Humans , Male , Middle Aged , Prospective Studies , Spain , Young AdultABSTRACT
La neumonía comunitaria es una importante causa de morbimortalidad en la especie humana. La valoraciónde la gravedad de la neumonía es una herramienta fundamental para la asistencia de estos pacientes alpermitir estratificarlos según el riesgo de muerte y poder proporcionar la intensidad de tratamiento másadecuada. Las escalas más utilizadas son el escala de PSI/Fine y CURB-65, fácilmente calculables en la prácticaclínica y ampliamente validadas. Por otra parte, la adición de biomarcadores a dichas escalas ha demostradoaumentar su precisión la predicción de complicaciones y mortalidad.El diagnóstico etiológico de la neumonía sigue constituyendo un reto para el clínico. Recientemente, y conla experiencia adquirida en la pandemia de gripe A H1/N1 en 2009, se han implementado el diagnósticovirológico de la neumonía por técnicas rápidas de reacción en cadena de la polimerasa así como la adquisiciónde experiencia con el tratamiento antiviral y las complicaciones, sobre todo la sobreinfección bacterianacomo principal evento desfavorable en las neumonías virales.Del mismo modo que el uso de la antibioterapia para el tratamiento de las infecciones cambió radicalmenteel pronóstico y el tratamiento de éstas, progresivamente aparecen referencias en la bibliografía del efectoinmunomodulador de fármacos que no han estado inicialmente diseñados para el tratamiento de la neumonía,abriendo un horizonte esperanzador por el potencial papel modificador de la evolución en estospacientes(AU)
Community-acquired pneumonia is a major cause of morbidity and mortality. Severity assessment is afundamental tool in the management of pneumonia that allows patients to be stratified according to risk ofdeath and the most appropriate treatment intensity to be provided. The most widely used scales are thePSI/Fine and CURB-65 scales, which have been widely validated and are easy to calculate in clinical practice.Biomarkers can additionally be used to increase accuracy in predicting complications and mortality.Etiologic diagnosis of pneumonia continues to pose a challenge to clinicians. With the experience acquiredin the 2009 AH1/N1 influenza pandemic, virological diagnosis of pneumonia by rapid polymerase chainreaction techniques has recently begun to be used. Experience has also been gained in antiviral treatmentand complications, especially bacterial superinfection as the main unfavorable event in viral pneumonias.Just as the use of antibiotics to treat infections radically changed their prognosis and treatment, reports inthe literature have progressively began to appear of the immunomodulatory effect of drugs that were notinitially designed for the treatment of pneumonia, leading to hope for the potential modification ofoutcome in these patients(AU)
