title: Cost and clinical consequence of antibiotic non-adherence in acute exacerbations of chronic bronchitis.
abstract: OBJECTIVE
  To quantify the impact of non-adherence on the clinical effectiveness of antibiotics for acute exacerbations of chronic bronchitis (AECB) and to estimate the economic consequences for Spain, Italy and the United States.
  
  
  METHODS
  Standard systematic reviewing procedures were followed to identify randomised controlled clinical trials of antibiotic treatment for acute respiratory tract infection for which adherence was reported. A decision-analytic model was then constructed to evaluate the impact of non-adherence to antibiotic treatment on clinical effectiveness and costs per AECB episode. The model compared the total treatment costs, cure rates and incremental costs per cure for a poor compliance group (PCG) against a good compliance group (GCG). Clinical and resource use estimates were from the published literature and physician surveys.
  
  
  RESULTS
  Twenty-five articles met the criteria of the systematic review, although only one reported treatment success by adherence status. The relative risk of clinical effectiveness if non-adherent was 0.75 (95%CI 0.73-0.78). Based on this single study, the model predicted that 16-29% more patients would be cured in the GCG vs. the PCG, and payers would save up to euro122, euro179 and US$141 per AECB episode in Spain, Italy and the United States, respectively.
  
  
  CONCLUSIONS
  Non-adherence to antibiotics for AECB may have an impact on clinical effectiveness, which is associated with increased costs.
authors.affiliation: United BioSource Corporation, Bethesda, Maryland, USA.
authors.forename: S V
authors.initials: SV
authors.lastname: Sorensen
authors.forename: T
authors.initials: T
authors.lastname: Baker
authors.forename: R
authors.initials: R
authors.lastname: Fleurence
authors.forename: J
authors.initials: J
authors.lastname: Dixon
authors.forename: C
authors.initials: C
authors.lastname: Roberts
authors.forename: S
authors.initials: S
authors.lastname: Haider
authors.forename: D
authors.initials: D
authors.lastname: Hughes
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001991:Bronchitis / Q000188:drug therapy* / Q000191:economics; D003365:Costs and Cost Analysis; D003661:Decision Support Techniques; D018450:Disease Progression; D006801:Humans; D007558:Italy; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D013030:Spain; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents