Benhamou, F

Chevret, S

Corre A, LE

Elkharrat, D

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186 Abstracts
agement of SM. The IGP is a practical method for reaching
consensus involving complicated decision processes such
as SM.
PID11
COST-EFFECTIVENESS OF FIVE ORAL 
ANTIMICROBIALS FOR ACUTE OTITIS MEDIA
Kaplan-Machlis B1, Wandstrat TL2, Beane JS1
1West Virginia University, School of Pharmacy, Charleston, 
WV, USA; 2Novartis Pharmaceuticals, Inc., East Hanover, NJ, 
USA
OBJECTIVES: To compare direct and indirect costs of
treating acute otitis media (AOM) using five antimicrobials. 
METHODS: In this study 263 patients, mean age 35.2
months (SD 23.0), were enrolled from six primary care
clinics in a prospective, randomized, naturalistic cost-
effectiveness trial. Inclusion criteria were age 6 months
and 8 years, clinical diagnosis of AOM, physician re-
quiring antimicrobial treatment, and no antimicrobial re-
ceived within 30 days. Patients with allergies to the study
antimicrobials were excluded. Direct costs included phy-
sician, clinic, laboratory, procedure charges, antimicrobi-
als, ancillary medications, side effects, and revisits. Indi-
rect costs included travel, loss of parental income, and
baby-sitter fees. After giving informed consent, patients
were randomized to amoxicillin (N  53), amoxicillin/
clavulanate (N  52), azithromycin (N  60), clarithro-
mycin (N  48), or cefixime (N  50) treatment and fol-
lowed for 30 days. Biweekly telephone surveys of patient
caregivers and chart reviews were used to collect resource
utilization data. 
RESULTS: Total cost of treatment was lowest with
azithromycin, $130.85 (SD 79.50), and highest with ce-
fixime, $180.69 (SD 90.48), p  0.081. Statistically signif-
icant differences among antimicrobial costs were observed;
lowest mean cost was amoxicillin, $5.71 (SD 1.50) and
highest was cefixime, $63.56 (SD 8.12), p  0.0001. Al-
though not statistically significant, total direct costs of
treatment were lower with azithromycin, $81.12 (SD
43.67) than amoxicillin, $94.32 (SD 59.43), p  0.69. 
CONCLUSIONS: Statistically significant differences in
total costs between antimicrobials in treating AOM were
not observed.
PID12
THE RATE OF INFECTIONS CONCURRENT 
WITH INTRAVENOUS PATIENT-CONTROLLED 
ANALGESIA
Shmuely Y, Lydick E
SmithKline Beecham, Philadelphia, PA, USA
OBJECTIVE: To evaluate the rate of infections concur-
rent with morphine intravenous patient-controlled anal-
gesia (PCA) and estimate the costs that are associated
with these infections (such as length of stay and hospital
charges). 
METHODS: This database study sample included 27,737
hospital patients greater than 6 years old, from hospital-
ized patients who were discharged during October 1995
through September 1996 from a sample of 59 US hospi-
tals. Line-related infection was defined as Staphylococcal
septicimia, the most common form of line-related infec-
tion. Patients with a primary diagnosis of staphylococcus
septicemia were removed prior to analysis. 
RESULTS: The rate of infections among morphine IV
PCA users in was 0.5% (140/27,737). Patients with in-
fections have a statistically significant higher death rate
(25.1%) than patients without line-related infections
(8.9%). Moreover, patients with infections had statisti-
cally significantly longer median length of stay in the hos-
pital (22.5 days) than patients without line-related infec-
tions (8 days). Consequently, median hospital charge for
patients with line-related infections is statistically signifi-
cantly higher ($53,130.57) than for patients without line-
related infections ($18,981.43). A nested case-control com-
parison whereby patients with infections were matched to
controls based on age, gender, and primary diagnosis, pro-
duced similar results. 
CONCLUSION: Line-related infections add substantially
to the cost of care, compared with costs for uninfected
patients.
PID13
LONG-TERM EFFICACY OF LOCAL GUIDELINES 
TO IMPROVE ANTITETANUS PROPHYLAXIS 
AND REDUCE COSTS IN AN EMERGENCY 
DEPARTMENT
Elkharrat D, Chevret S, Le Corre A, Benhamou F
Emergency Department, Hôpital Lariboisière, Paris, France
Antitetanus prophylaxis (ATP) is based on the WHO rec-
ommendations that cause overprescribing of tetanus im-
munoglobulins (TIg) in over 40% of cases. An interven-
tion to reduce prescribing of unwarranted TIg was
conducted.
METHODS: The intervention combined locally devel-
oped guidelines (LDG) to a 4-month teaching program.
Before the intervention: 1) TIg prescribed for patients
with open wounds were retrospectively collected during
66 months (I  66), 2) ATP delivered according to WHO
guidelines was prospectively studied in consecutive pa-
tients with open wounds during the month preceding the
intervention. After the intervention we prospectively
studied: 1) ATP according to LDG during the month fol-
lowing the intervention, 2) then TIg prescribed during 26
months afterwards (I  26).
RESULTS: The intervention took place between June
and September 1995. The number of patients with open
wounds increased from 6933 in 1990 to 7922 in 1997.
TIg prescribed to them decreased from 60% at (I  66)
to 23% of 389 consecutive patients prospectively studied
1 month before the intervention, to 1% (p  10–3) of
459 consecutive patients observed 1 month thereafter.
The reduction of TIg prescribing was maintained below
Abstracts 187
1% at (I  26). The application of chronological series
indicates that this decrease is significantly correlated to
the effects of the intervention (p  0.02). In addition, the
costs of ATP decreased from $40 to $24. 
CONCLUSIONS: 1) An important reduction of TIg pre-
scribing was obtained after the introduction of new
guidelines in our emergency department and is main-
tained 3 years later. 2) Rapid techniques are needed to
identify extemporaneously patients who require TIg.
PID14
ECONOMIC ANALYSIS OF ANTIMICROBIAL 
AGENTS FOR HOSPITAL-ACQUIRED 
PNEUMONIA
Wong AH, Oh PI, Shear NH
HOPE Research Centre, Sunnybrook & Women’s College 
Health Science Centre, Toronto, Ontario, Canada
Hospital-acquired pneumonia (HAP) is associated with a
high mortality rate and a substantial economic burden.
Many clinical and economic studies do not differentiate
between HAP in the intensive care unit (ICU) versus on
the ward, even though they are associated with different
pathogens, treatment approaches, mortality and costs.
For nosocomial infections, the effectiveness of therapy is
dependent on the pathogenic organism and susceptibility
to prescribed antibiotics, factors that are specific to each
individual institution. 
OBJECTIVES: To develop decision analytic models for
current and anticipated antimicrobial regimens for the
initial treatment of ICU and non-ICU HAP, that incorpo-
rate site-specific pathogen and susceptibility profiles,
from the hospital perspective. 
METHODS: Two decision tree models were constructed,
one for ICU and the other for non-ICU HAP. The proba-
bilities for the decision analysis model were derived from
a meta-analysis of randomized, controlled clinical trials
and data from our hospital population. Antimicrobial
susceptibilities were obtained from the literature and lo-
cal data. The comparators included in the baseline analy-
sis were cefotaxime (CFX), ceftazidime (CTZ), ceftriax-
one (CTR), ciprofloxacin (CIP), imipenem (IMP), and
cefazolin  gentamicin (CG). Drug acquisition, phar-
macy, nursing, and hospitalization costs were included in
the analysis. Hospitalization costs were determined from
local case-costing data. Outcomes were measured as suc-
cess, failure, and death. 
RESULTS: For ICU HAP, CG dominated over IMP.
The incremental cost-effectiveness ratios for CTZ and
CIP were $66,087/success and $49,099/success, respec-
tively. For non-ICU HAP, CG dominated over CTR
and CFX. The incremental ratio for CTZ was $142,500/
success. Sensitivity analyses did not substantially alter the
results. 
CONCLUSIONS: Antimicrobial susceptibility is a clini-
cally important determinant of efficacy that should be in-
cluded in economic analyses of HAP and other infections.
PID15
INFLUENCE OF MOTIVATING FACTORS AND 
BARRIERS ON INFLUENZA VACCINATION IN 
AN EMPLOYED POPULATION
Parasuraman TV1, Patterson R1, Toscani MR1, Coleman MJ2, 
Pizzi LT1
1Hastings Healthcare Group, Inc., Pennington, NJ, USA; 
2Wyeth-Ayerst Pharmaceuticals, St. Davids, PA, USA
OBJECTIVES: The purpose was to identify motivating
factors and barriers on influenza vaccination. 
METHODS: An employer site conducting an annual influ-
enza vaccination program was selected for the study. Sub-
jects were recruited on-site to participate in the 5-month
study. The vaccinated group (VG) included subjects pre-
senting for vaccination over a 3-week vaccination schedule
in October 1998. During a subsequent 3-week period, vol-
unteers not receiving vaccination (NVG) were recruited
into the study. Health Belief surveys were administered at
the time of recruitment, which included questions specifi-
cally inquiring about health beliefs. The Health Belief
Model (HBM) was utilized to derive motivators, barriers,
threats, and expectations regarding influenza vaccination
and their influence on getting vaccinated. The influence of
the motivating factors and barriers were rated on a 4-point
rating scale (1  none, 4  a great deal). 
RESULTS: Preliminary results of motivating factors and
barriers on 1065 subjects (663 VG and 402 NVG) who
completed the surveys are presented. “Avoid influenza”
was reported most often as having a great deal of influ-
ence on getting vaccinated (86%, 524/606 subjects) fol-
lowed by “transmit influenza” (53%, 307/575 subjects).
Fear of injection and site pain (32%, 96/298 subjects)
and inconvenience (32%, 96/297 subjects) were reported
most often as having a great deal of influence as barriers
to vaccination. Additional multivariate analyses incorpo-
rating all aspects of HBM are ongoing. 
CONCLUSIONS: Perception of contracting and/or
transmitting influenza were primary motivators for seek-
ing vaccination. In the survey, there appear to be multiple
barriers to vaccination. Communication strategies and
noninvasive formulations of influenza vaccines may di-
minish these barriers and enhance vaccination rates.
PID16
ECONOMIC STUDY OF CEPHALOSPORINS IN 
THE TREATMENT OF MODERATE LOWER 
RESPIRATORY TRACT INFECTION
Zhigao HE, Chen J
Department of Hospital Management, Shanghai Medical 
University, Shanghai, China
The amount of antibiotics currently used in the hospital
has reached 35% of total drug consumption. The exten-
sive usage of antibiotics has not only brought drug resis-
tance, but also increased the economic burden of pa-
tients. Controlling the abuse of antibiotics and how to


PID13: LONG-TERM EFFICACY OF LOCAL GUIDELINES TO IMPROVE ANTITETANUS PROPHYLAXIS AND REDUCE COSTS IN AN EMERGENCY DEPARTMENT 

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PID13: LONG-TERM EFFICACY OF LOCAL GUIDELINES TO IMPROVE ANTITETANUS PROPHYLAXIS AND REDUCE COSTS IN AN EMERGENCY DEPARTMENT

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