The clinical and economic benefits of administering piperacillin-tazobactam by continuous infusion.

Beta-lactam antibiotics, such as piperacillin-tazobactam, are commonly administered frequently throughout the day as intermittent infusions over a period of 30-60 min. However, increasing knowledge of how these antibiotics kill bacteria has made continuous infusion a valuable option to achieve maximal clinical outcomes while consuming the least amount of institutional resources. Continuous infusion of piperacillin-tazobactam is currently used at our hospital because of its clinical and economic benefits when compared with intermittent infusion. This article will review our experience with the administration of piperacillin-tazobactam by continuous infusion and the numerous advantages we have documented. Additionally, advantages related to a reduction in nursing resource consumption will be a focus of discussion.

National trends in the outpatient treatment of anxiety disorders.

BACKGROUND: Recent advances in psychotherapy and pharmacotherapy have increased the number of treatment options for anxiety disorders. This article examines changes in outpatient treatment of anxiety disorders in the United States between 1987 and 1999. METHOD: Analyses are presented of service utilization data from 2 nationally representative surveys of the general population: the 1987 National Medical Expenditure Survey and the 1999 Medical Expenditure Panel Survey. Respondents were selected who made 1 or more outpatient visits for the treatment of an anxiety disorder (ICD-9/DSM-IV: 300.0, 300.2, 300.3, or 308.3). The rates of treatment, psychotropic medication use, psychotherapy, number of outpatient treatment visits, type of provider, and source of payment were determined. RESULTS: The rate of outpatient treatment for anxiety disorders increased from 0.43 per 100 persons in 1987 to 0.83 in 1999 (p <.001). Among those treated for an anxiety disorder, the proportion that received psychotropic medications increased from 52.1% to 69.9% (p =.008). Among treated patients, antidepressant use increased from 18.3% to 44.9% (p <.0001), while use of benzodiazepines (42.3% to 31.7%, p =.09) and psychotherapy (60.5% to 48.0%, p =.07) tended to decline. A decreasing proportion of mean treatment expenditures was covered by self-payment (53.2% to 31.5%, p <.0001). CONCLUSION: Between 1987 and 1999, there was an increase in the proportion of the population who received outpatient treatment for anxiety disorders. Among patients receiving care, treatment became characterized by greater use of psychotropic medications, especially antidepressant medications, with nonsignificant trends toward less common use of psychotherapy.

Cost and effectiveness of venlafaxine extended-release and selective serotonin reuptake inhibitors in the acute phase of outpatient treatment for major depressive disorder.

OBJECTIVE: The purpose of this retrospective analysis was to estimate the cost and effectiveness of venlafaxine extended-release (VXR) compared with selective serotonin reuptake inhibitors in the outpatient treatment of major depressive disorder. METHODS: Pooled data from 8, 8-week, randomized, double-blind studies comparing treatment of major depressive disorder with venlafaxine/venlafaxine XR (n = 851), selective serotonin reuptake inhibitors (fluoxetine, paroxetine, fluvoxamine; n = 748), or placebo (4 studies; n = 446) were retrospectively analyzed to determine the economic implications of symptom remission from the perspective of a US third party payer and that of an employer. A decision modeling approach was used to determine cost and effectiveness ratios. RESULTS: Patients on VXR were associated with 22.8 depression-free days versus 18.6 depression-free days with the studied selective serotonin reuptake inhibitors, based on the decision model. Productive and quality-adjusted days were also expected to increase for VXR patients (22.06 vs. 19.34 and 4.56 to 9.36 vs. 3.72 to 7.63), as was the percentage of patients achieving full activity (25.9% vs. 19.6%). The expected cost per patient achieving remission of symptoms was US 1303.94 dollars and US 1514.96 dollars, and the cost per depression-free days was US 25.66 dollars and US 28.25 dollars, for the VXR and selective serotonin reuptake inhibitors groups, respectively. CONCLUSIONS: Treatment with VXR is not only expected to increase the rate of remission of symptoms but is also associated with achievement of full activity, higher number of depression-free days, productive days, and quality-adjusted days. VXR is a cost-effective treatment option for major depressive disorder.

Acute and continuation treatment adequacy with venlafaxine extended release compared with fluoxetine.

STUDY OBJECTIVE: To compare treatment adequacy in the management of depression during the acute and continuation phases between patients newly treated with venlafaxine extended release (XR) and those newly treated with fluoxetine. DESIGN: Retrospective observational analysis of pharmacy claims data. SETTING: Large California-based managed care organization. PATIENTS: A total of 11,298 patients newly prescribed venlafaxine XR or fluoxetine between January 1, 2000, and February 28, 2001, and continuously enrolled throughout the study, as well as a subset of 7430 patients who continued taking venlafaxine XR or fluoxetine during the follow-up period. MEASUREMENTS AND MAIN RESULTS: The Health Plan Employer Data and Information Set definition was used for continuous antidepressant treatment during the acute and continuation phases. Treatment adequacy was determined for those deemed continuous. Patients receiving within +/- 10% of the target dose for each drug (venlafaxine XR 75-150 mg, fluoxetine 20 mg) were defined as receiving an adequate dose. Logistic regression was used to evaluate venlafaxine XR versus fluoxetine on treatment adequacy, controlling for age, sex, physician specialty, and pharmacy benefit. The unadjusted adequacy rate for the venlafaxine XR-only group was 79% versus 57% for the fluoxetine-only group for 84 continuous days (p<0.0001) and 77% versus 52%, respectively, for 180 continuous days (p<0.0001). The adjusted odds ratios of achieving treatment adequacy with venlafaxine XR only versus that with fluoxetine only were 3.05 (95% confidence interval [CI] 2.65-3.52) for 84 continuous days and 3.57 (95% CI 3.00-4.24) for 180 continuous days. CONCLUSION: Patients newly prescribed venlafaxine XR were at least 3 times more likely to achieve treatment adequacy for 84 and 180 days compared with those newly prescribed fluoxetine. Treatment adequacy as a proxy for optimal treatment may be an important factor to consider when selecting an antidepressant drug.

Cost analysis of continuous versus intermittent infusion of piperacillin-tazobactam: a time-motion study.

The time and associated costs (drug, labor, supply) of administering a continuous versus an intermittent i.v. infusion of piperacillin-tazobactam were compared. The total labor cost was calculated for each regimen based on the time required for nurses, pharmacists, and pharmacy technicians to either prepare or administer the drug, according to their standard responsibilities. Thirty timed observations were made for each of the dosing formulations. Observations were conducted on separate occasions for at least four different nurses, pharmacists, and pharmacy technicians per formulation. Labor costs were calculated by multiplying the mean times recorded by the average U.S. hourly wages and local wages for these health professionals and extrapolated to encompass a 24-hour period of drug administration. The average wholesale price and hospital contract price of piperacillin-tazobactam were used to calculate the costs of both intermittent and continuous infusions. The costs for all items used in drug preparation and administration were also calculated for supplies. Basic descriptive statistics were used to evaluate the costs of the time needed to prepare and administer the different regimens. Drug acquisition costs accounted for the largest percentage of the total cost for all regimens. Analysis of labor costs revealed that nursing time accounted for the majority of the labor costs, with continuous infusion regimens being the least time-consuming and least costly administration method. Continuous-infusion regimens were more cost-efficient when evaluated on a daily basis and for the total cost of 5- and 10-day treatments. The use of continuous infusion as a means of administering piperacillin-tazobactam maximized the drug's pharmacodynamics and was more cost-efficient than intermittent infusion of the drug.

Comorbidities and associated treatment charges in patients with anxiety disorders.

OBJECTIVE: To describe comorbidities and treatment charges in patients receiving initial anxiolytic therapy for anxiety disorders. DESIGN: Retrospective data analysis. PATIENTS: Six thousand six hundred forty-seven patients with anxiety disorders. MEASUREMENTS AND MAIN RESULTS: Analysis was conducted using medical and pharmacy data for patients in 26 United States health plans from the PharMetrics Integrated Outcomes database. Data were collected for 12 months before and after the first anxiolytic prescription date (index date) during the study period (January 1, 1998-December 31, 2000). The sample comprised patients with a diagnosis of anxiety disorder whose original anxiolytic prescription had been refilled within 120 days. International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes and medical and prescription data identified the existence of comorbidities, and medical and prescription charges. The most common diagnoses of anxiety disorder were anxiety not otherwise specified (67%), panic disorder (14%), and generalized anxiety disorder (13%). The most commonly prescribed anxiolytics were benzodiazepines, such as alprazolam (43%) and lorazepam (27%). Hypertension was the most common nonpsychiatric comorbidity (22%) and depression the most common psychiatric comorbidity (37%). Other comorbidities observed were lipid disorders (17%), chronic obstructive pulmonary disease (9%), and asthma (7%). Total treatment charges 12 months before and after initial anxiety diagnosis and anxiolytic prescription were dollar 6279 and dollar 9270, respectively (p < 0.0001). CONCLUSION: Chronic conditions are commonly associated with anxiety disorders. Recognizing these psychiatric and nonpsychiatric comorbidities is important when treating patients with these disorders. Treatment charges are significantly higher when a patient is diagnosed with an anxiety disorder, highlighting the impact of anxiety on the total cost of treatment for these patients.