Contreras-Hernandez, I

Davila-Loaiza, G

Mould-Quevedo, J

Salinas-Escudero, G

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PRS4 AN ECONOMIC EVALUATION OF FIRST LINE ANTIBIOTICS FOR THE INPATIENT TREATMENT OF ACUTE EXACERBATIONS OF CHRONIC BRONCHITIS IN MEXICO 

A178 Abstracts
and incremental costs of three different types of respiratory infec-
tions: acute sinusitis (AS), acute otitis media (AOM), and com-
munity-acquired pneumonia (CAP). METHODS: Data were
from the Marketscan claims databases July–December 2004.
Respiratory disease episodes were constructed via ICD9 codes
on an index and surrounding claims. The antibiotics most fre-
quently prescribed initially for each type of infection were iden-
tiﬁed. Logistic regression estimated a propensity score for each
patient; which was the predicted probability of using a reference
drug, telithromycin. Patients were matched according to this
probability and exponential conditional means models (ECM)
were speciﬁed, controlling signiﬁcant variables after the propen-
sity score matching (demographics and comorbidities). These
models allowed incremental costs to be estimated for treatment
with the reference drug, telithromycin, relative to other antibi-
otics. RESULTS: There were 86,232 AS, 71,884 AOM (10%
were among patients under 18) and 5236 CAP episodes. The
most commonly used antibiotic for initial treatment was amox-
icillin for AOM, and AS and azithromycin for CAP. Total costs
were $182 for AS, $192 for AOM and $897 for CAP. The
highest incremental cost saving associated with telithromycin
was relative to moxiﬂoxacin in CAP ($484; p < 0.001). The
highest incremental cost saving with another antibiotic relative
to telithromycin was $23.43 (p < 0.001) in the AS episodes ini-
tiated with azithromycin. CONCLUSION: The multivariate
results showed that after propensity matching and controlling for
intra-episode differences, that direct costs did indeed vary by the
initiating antibiotic. It is of interest to note that the results did
not uniformly favor one agent over another. Although different
antibiotics may be included in the same drug class, there are
clearly differentials between these drugs to consider not only
clinically, but also for ﬁnancial implications as well.
PRS4
AN ECONOMIC EVALUATION OF FIRST LINE ANTIBIOTICS
FOR THE INPATIENT TREATMENT OF ACUTE
EXACERBATIONS OF CHRONIC BRONCHITIS IN MEXICO
Salinas-Escudero G1, Contreras-Hernandez I1, Mould-Quevedo J2,
Davila-Loaiza G2
1Social Security Mexican Institute, Mexico City, Mexico, 2Pﬁzer
Mexico, Mexico City, Mexico
OBJECTIVES: The purpose of the study was to evaluate eco-
nomic and health consequences of ﬁrst line antibiotics treatment
for inpatient therapy in Mexican patients with acute exacerba-
tions of chronic bronchitis (AECB) from the health care payer’s
perspective. METHODS: A cost—effectiveness assessment was
performed employing two economic models. First, a three-month
decision tree model was used to compare costs and effectiveness
associated to acute exacerbations treatments. Second, a one-year
Markov model was created to compare costs and effectiveness
associated to AECB recurrences. Model comparators were: gemi-
ﬂoxacin 320 mg/day, moxiﬂoxacin 400 mg/day, levoﬂoxacin 
500 mg/day, ceftriaxone 1 gr/day, gatiﬂoxacin 400 mg/day, clar-
ithromycin 1000 mg/day and cefuroxime 1000 mg/day. The
effectiveness measures were the % of clinical success and the
number of free months of recurrences/hospitalizations. Resource
use data was obtained from hospital records inside the General
Regional Hospital No. 1 “Gabriel Mancera” at the Social Secu-
rity Mexican Institute (IMSS) in Mexico City (n = 117). All drug
prices and resource use costs were taken from ofﬁcial institu-
tional databases from the IMSS. One-way and probabilistic sen-
sitivity analyses were performed and components analyses were
elaborated. RESULTS: Gemiﬂoxacin showed the lowest expected
costs (US$2750.2); the highest % of clinical success among all
alternatives (97.5%) and the shorter hospitalization stay length
(approximately 6.1-days). The total days reduction generated 
by gemiﬂoxacin could reduce total hospitalization costs in
$US1269.5 per acute exacerbation. Markov model results for
free months of recurrences showed that gemiﬂoxacin ﬁrst line
therapy for AECB could give patients in average 11.1-free
months of recurrences/hospitalizations followed of ceftriaxone
(10.9-months) and moxiﬂoxacin (10.5-months). The results were
robust to ﬁrst-order Monte Carlo simulations and acceptability
curves. CONCLUSION: Gemiﬂoxacin is the most cost effective
ﬁrst line treatment for inpatients with AEBC, because its high
effectiveness, signiﬁcant inpatients day’s reduction and more free
months of recurrences. These results could be used by Mexican
decision-makers to generate future cost-containment strategies.
PRS5
COST—EFFECTIVENESS ANALYSIS OF FIRST LINE
ANTIBIOTICS FOR THE INPATIENT TREATMENT OF PATIENTS
WITH COMMUNITY ACQUIRE PNEUMONIA IN A PUBLIC
MEXICAN HOSPITAL
Salinas-Escudero G1, Contreras-Hernandez I1, Mould-Quevedo J2,
Davila-Loaiza G2
1Social Security Mexican Institute, Mexico City, Mexico, 2Pﬁzer
Mexico, Mexico City, Mexico
OBJECTIVES: The purpose of the study was to estimate the
incremental cost-effectiveness ratios (ICER) among the ﬁrst-
line antibiotics for the inpatient treatment of Mexican patients
with community acquired pneumonia (CAP) from the health 
care payer’s perspective. METHODS: A cost—effectiveness
analysis was performed with the aid of a decision tree model.
The model had a two-month period to assess economic and 
clinical consequences of seven ﬁrst-line antibiotics used in the
study: Gemiﬂoxacin 320 mg/day, Clarithromycin 1000 mg/day, 
Levoﬂoxacin 500 mg/day, Gatiﬂoxacin 400 mg/day, Ceftriaxone
1 gr/day, Cefuroxime 1500 mg/day and Moxiﬂoxacin 400 mg/
day. Adverse events of each therapy were considered (rash, diar-
rhea, dizziness, vomits, chill and head pain). Resource use data
was obtained from hospital records from the General Regional
Hospital No. 1 “Gabriel Mancera” at the Social Security
Mexican Institute (IMSS) in Mexico City (n = 94). All drug prices
and unit costs were taken from ofﬁcial institutional databases
within the IMSS. Effectiveness measures used in the model was
the % of therapeutic success among the multiple antibiotics.
One-way and probabilistic sensitivity analyses were performed
and acceptability curves were constructed. RESULTS: Gemi-
ﬂoxacin showed the lowest average health care costs in inpatient
treatment (US$ 2389.8) due to a signiﬁcant reduction in the 
hospitalization days (approximately 4.61 days in average per
patient). The length of stay reduction was associated with the
shorter treatment of gemiﬂoxacin (ﬁve-days). Gemiﬂoxacin
showed the highest effectiveness (95.3%) followed by clar-
ithromycin (94.3%); levoﬂoxacin (94.0%); gatiﬂoxacin
(92.0%); ceftriazone (91.3%); cefuroxime (90.0%) and moxi-
ﬂoxacin (86.5%). The ICERxs for all treatments were dominated
by gemiﬂoxacin. First-order Monte Carlo simulations showed
the same results. CONCLUSION: Gemiﬂoxacin was the most
cost effective ﬁrst line treatment for hospitalized patients with
CAP, especially, because it’s high effectiveness and its signiﬁcant
inpatient-stay length reduction.
PRS6
EVALUATING THE COST-EFFECTIVENESS OF TIOTROPIUM IN
THE TREATMENT OF MODERATE CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
Naik S, Kamal KM, Keys P, Mattei T
Duquesne University, Pittsburgh, PA, USA


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PRS4 AN ECONOMIC EVALUATION OF FIRST LINE ANTIBIOTICS FOR THE INPATIENT TREATMENT OF ACUTE EXACERBATIONS OF CHRONIC BRONCHITIS IN MEXICO

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