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OBJECTIVES: To measure costs associated with treatment failure among patients
with moderate or complicated CA-MRSA skin infections. METHODS: This was a
prospective, observational study in 4 primary care clinics within the South Texas
Ambulatory Research Network (STARNet). Health care providers collected clinical
data, wound swabs, and 90-day follow-up information. Patients were considered to
have moderate or complicated infections if they had a lesion 5 cm in diameter,
diabetes mellitus, or both. Patients experienced treatment failure if any of the
following occurred within 90 days of their initial visit: 1) change in antibiotic ther-
apy; 2) subsequent need for incision and drainage [I&D]; 3) subsequent positive
MRSA culture; or 4) hospital admission. The cost analysis was performed from the
perspective of the health insurance payer. Medical costs were derived using esti-
mates from the Agency for Healthcare Research and Quality. National Average
Drug Acquisition Costs, obtained from the Centers for Medicare and Medicaid Ser-
vices, were used to estimate drug costs. All costs were adjusted to 2011 United
States dollars using national medical-care inflation rates. RESULTS: One-third of
patients with moderate or complicated CA-MRSA infections experienced treat-
ment failure (n11/36, 31%). Of the 11 who failed therapy, 91% required a change in
antibiotic regimen at an additional mean cost of $4 per person. Eighty percent of
patients who required a change in antibiotics received trimethoprim-sulfame-
thoxazole as initial antibiotic therapy. Patients frequently required the addition of
either clindamycin (50%) or doxycycline (30%) to their initial antibiotic regimen.
Additional I&D procedures were necessary in 27% of patients at a mean cost of
$2130 per person. Finally, 9% of patients required hospitalization at a mean cost of
$17,590 per person. The overall mean cost of treatment failure was $2184 per pa-
tient. No adverse drug events were reported. CONCLUSIONS: One-third of adult
outpatients with moderate or complicated CA-MRSA skin infections will experi-
ence treatment failure at a mean cost of $2184 per patient.
PIN18
COST OF PNEUMOCOCCAL DISEASES IN MEXICO WITH PATIENTS OLDER THAN
50 YEARS OLD: A MICRO-COSTING APPROACH
Peniche-Otero G1, Echaniz-Aviles G2, Herrera-Rojas J1, Ramírez-Ramírez MA1,
Mercado G3,Galindo-Suárez RM3
1Customized Premium Products S.A. de C.V., Mexico City, Mexico, 2Instituto Nacional de Salud
Pública, Cuernavaca, Morelos, Mexico, 3Pfizer S.A. de C.V., Mexico City, Mexico
OBJECTIVES: Streptococcus pneumoniae is one of the most important etiologic
agents of both, respiratory infections and systemic invasive diseases, with signif-
icative rates of morbidity and mortality in the elderly, which represents an eco-
nomic burden. There are few published studies describing the cost of care for
elderly patients with pneumococcal disease in Latin America. The goal of this study
is to estimate the direct medical costs of the acute phase of pneumococcal diseases,
it=s complications and sequelae in elderly patients in Mexico, regarding the per-
spective of the Social Security Mexican Institute (IMSS). METHODS: Resource use in
the treatment of pneumonia, bacteremia, meningitis and acute otitis media (AOM)
was extracted from 112 clinic files of patients 50 years with confirmed diagnosis
of pneumococcal disease, treated at Guadalajara, Monterrey and Mexico City hos-
pitals, using a micro-costing approach (bottom-up strategy). Items included in the
analysis were: drugs, laboratory tests, outpatient and inpatient care, rehabilitation,
procedures and surgical interventions. Resource use for the treatment of compli-
cations and sequelae were derived trough a Delphi panel (n13, infectologists,
pediatricians and internist physicians, IMSS). Concordance index for the Delphi
panel results was estimated. The unit cost of medical resources was extracted from
institutional source. RESULTS: The estimated direct cost (2011 US) associated to
acute phase of pneumococcal diseases were: AOM $323, outpatient pneumonia
$172, inpatient pneumonia $4,718, bacteremia $7,698, meningitis $10,687. Cost of
complications (such as systemic, respiratory, cardiac, etc.) was: AOM US$671, out-
patient pneumonia US$1,502, inpatient pneumonia US$5,157, bacteremia
US$11,267, meningitis US$8,060. The costs of sequelae (such as cardiac, neurologic,
auditive, etc.) were: AOM US$593, outpatient pneumonia US$18, inpatient pneu-
monia US$1,560, bacteremia US$ 1,573, meningitis US$13,297. CONCLUSIONS: The
high institutional costs associated with pneumococcal disease, as well as its com-
plications and sequelae, merit that decision makers maintain and promote preven-
tion policies for this disease in the elderly.
PIN19
COSTS OF PROBABLE VIRAL DIARRHEA IN CHILDREN UNDER FIVE YEARS OLD
IN COLOMBIA
Alvis N1, Orozco-Africano JM1, Paternina-Caicedo A1, Coronell W1, Jervis-Jálabe D1,
De La Hoz F2
1Universidad de Cartagena, Cartagena, Bolívar, Colombia, 2Universidad Nacional de Colombia,
Bogotá D.C., Cundinamarca, Colombia
OBJECTIVES: To estimate the economic cost of probable viral diarrhea in children
less than 5 years old in a 130,800-chlidren cohort in Colombia. METHODS: A de-
scriptive study of economic costs was made. A database of 2010 attentions of a
Health Insurer was analyzed. It has 1,254,000 affiliates (130,800 children under 5
years), resident in 12 Colombian departments. The cases were identified using
international classification of diseases version 10 (A080, A083, A084, A085, A09X).
The types, quantity and frequency of use of health services were measured. Types,
quantity and frequency of use of health services were measured. The prices of
services were extracted from the Colombian official prices. Median (interquartile
range: IQR) of direct cost and average length of stay (LOS) in days were calculated.
The costs were calculated for hospitals by levels of complexity to prices of 2011 and
converted to American dollars. RESULTS: A total of 1456 cases of probable viral
diarrhea were identified in children less than five years old. 184 cases (12.64%) were
outpatient. Of inpatients, 42.9% were low level of complexity (LOS: 4.4), 42.8% were
middle of complexity (LOS: 4.1), and 1.3% were high level of complexity (LOS: 3.4).
0.2% of patients required Intensive Care Unit (LOS: 12.6). The median of cost per
outpatient case was USD$82.8 (IQR: 51-483); the median of cost per inpatient case of
middle level of complexity was USD$94 (IQR: 17.4-296.6); and in high level of com-
plexity was US$130.4 (IQR: 81.6-222.6) and in ICU US$3.341 (IQR: 1862-4821). The
total cost of cases was US$182,000.3. CONCLUSIONS: Most probably viral diarrhea
cases are mild with low average of stay. Despite the introduction of the rotavirus
vaccine in early 2009, probably viral diarrhea in children under 5 years in Colombia
has a significant burden of disease in this cohort.
PIN20
COSTS OF PROBABLE BACTERIAL PNEUMONIA IN CHILDREN UNDER 5 YEARS
OLD IN COLOMBIA
Alvis N1, Orozco-Africano JM1, Paternina-Caicedo A1, Coronell W1, Jervis-Jálabe D1,
De La Hoz F2
1Universidad de Cartagena, Cartagena, Bolívar, Colombia, 2Universidad Nacional de Colombia,
Bogotá D.C., Cundinamarca, Colombia
OBJECTIVES: . To estimate the economic cost of bacterial pneumonia in children
less than 5 years old in a 130,800-chlidren cohort in Colombia. METHODS: .A
descriptive study of economic costs was made. A database of 2010 attentions of a
Health Insurer was analyzed. It has 1,254,000 affiliates (130,800 children under 5
years), resident in 12 Colombian departments. The cases were identified using
international classification of diseases version 10 (J189, J180, J159, J159, J188, J158,
J851, J18, A409, P361, A408). The types, quantity and frequency of use of health
services were measured. Types, quantity and frequency of use of health services
were measured. The prices of services were extracted from the Colombian official
prices. Median (interquartile range: IQR) of direct cost and average length of stay
(LOS) were calculated. The costs were calculated for hospitals by levels of complex-
ity to prices of 2011 and converted to American dollars. RESULTS: . A total of 1545
cases of probable bacterial pneumonia were identified in children less than five years
old (56.7% in under-2 years). 309 cases (20%) were outpatient. Of inpatients, 15.9% were
low level of complexity (LOS: 2.3), 78.1% were middle of complexity (LOS: 5.3), and 3.1%
were high level of complexity (LOS: 7.1). 2.9% of patients required Intensive Care Unit
(LOS: 18). The median of cost per outpatient case was USD$98 (IQR: 73–147); The me-
dian of cost per inpatient case of middle level of complexity was USD$254 (IQR: 156-
284); and in high level of complexity was US$488.6 (IQR:135.5-1064.7) and in ICU
US$5,016.5 (IQR:2,568-6,754). The total cost of cases was US$871.809. CONCLUSIONS: .
The cases of probable bacterial pneumonia in children under 5 years in Colombia are
a serious public health problem. Most cases are in under-2 years and inpatients of
hospitals of middle level of complexity.
PIN21
A REVIEW OF ECONOMIC STUDIES OF RUBELLA AND RUBELLA VACCINATION
Babigumira JB1, Morgan I2, Levin A3
1University of Washington, Seattle, WA, USA, 2St. Mary’s College of Maryland, St. Inigoes, MD,
USA, 3Independent Consultant, Bethesda, MD, USA
OBJECTIVES: To examine the economic evidence base, identify gaps in the evi-
dence, and propose potential areas of future enquiry into the economics of rubella,
congenital rubella syndrome (CRS) and rubella vaccination to support the planned
global expansion of rubella-containing vaccine (RCV) and the push towards poten-
tial rubella elimination and eradication. METHODS: A MEDLINE search was con-
ducted of articles published between 1980 and 2010 on costs of rubella and CRS
treatment and the costs, cost-effectiveness or cost-benefit of rubella vaccination.
The design and results of studies were reviewed and categorized by the country
income level. Gaps in the evidence of the costs of rubella and CRS and cost-effec-
tiveness of rubella vaccination and the potential for rubella eradication were
identified. RESULTS: Twenty-five studies were identified. Of the nineteen studies
conducted in high-income countries, 5 were cost analyses, 3 were cost-effective-
ness analyses and 11 were cost-benefit analyses. Of the five studies conducted in
upper middle-income countries, four were cost analyses and one was a cost-benefit
study. A single study was conducted in a lower middle-income country and was a
cost-benefit analysis. No studies were conducted in low-income countries. In the
review, CRS was estimated to cost between $1,994 and $13,482 per case annually or
between $50,000 and $63,990 lifetime in middle-income countries and $98,734 life-
time in high-income countries. The review also found that rubella vaccination
programs had favorable cost-effectiveness, cost-utility, or cost-benefit ratios in
high-income countries and middle-income countries. CONCLUSIONS: Rubella is
costly and rubella vaccination programs are highly cost-effective. However, in or-
der for research to support the drive towards rubella elimination and eradication,
additional studies are required in low-income countries, to tackle methodological
limitations, and determine the most cost-effective strategies for rubella vaccina-
tion.
PIN22
ECONOMIC BURDEN OF HOSPITALIZATION WITH ANTIBIOTIC TREATMENT FOR
ABSSSI IN THE UNITED STATES: AN ANALYSIS OFTHE PREMIER HOSPITAL
DATABASE
LaPensee KT, Fan W, Wang Y
The Medicines Company, Parsippany, NJ, USA
OBJECTIVES: Current guidelines for the treatment of acute bacterial skin and skin
structure infections (ABSSSI) recommend aggressive treatment, including hospi-
talization for patients whose infection is progressing despite empiric antibiotic
therapy. In such cases potentially involving S. aureus, guidelines suggest that cli-
nicians should use agents effective against MRSA because of the high prevalence of
community-associated MRSA strains. This study attempts to ascertain the US eco-
nomic burden and near-term outcomes of in-hospital treatment of ABSSSI during
recent years. METHODS: Using the Premier Hospital Database, hospitalization re-
A240 VALUE IN HEALTH 15 (2012) A1–A256
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