title: Clinical outcomes and cost analysis of exacerbations in chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Exacerbations are a major cause of disability, hospital admissions, and increased healthcare costs in patients with chronic obstructive pulmonary disease (COPD). This study investigated the clinical outcomes of outpatients with moderate to severe exacerbated COPD and their related costs.
  
  
  METHODS
  An observational study on the outcomes of ambulatory exacerbations of COPD was conducted. The course of the exacerbation was evaluated at a follow-up visit at 4 weeks. A cost analysis that encompassed the use of healthcare resources for treatment of the exacerbation was performed.
  
  
  RESULTS
  A total of 260 patients were included, with a mean age of 68.3 years and a mean FEV1 (% predicted) of 58.9 %. Twenty-two percent of patients had significant cardiovascular comorbidity. The most frequently prescribed antibiotics were moxifloxacin in 137 cases and amoxicillin-clavulanate in 50 cases. The rate of failure at 4 weeks was 12.5 %, with no differences between the two most prescribed antibiotics; however, patients treated with moxifloxacin had symptoms for 1.9 fewer days (P = 0.01). The mean cost of the exacerbation was <euro>344.96 (95 % CI: <euro>48.55-<euro>641.78), with 9.6 % of the costs for drugs and 72.9 % for hospital care of patients for whom treatment had failed.
  
  
  CONCLUSIONS
  Antibiotic treatment of our population was in compliance with local guidelines. The rate of failure observed in our study was lower than that reported in previous studies; however, the small percentage of patients that required hospital attention generated almost two-thirds of the total costs of the exacerbations.
authors.affiliation: Pneumology Department, Hospital Universitari Vall d'Hebron, P. Vall d'Hebron 119-129, 08035, Barcelona, Spain, mmiravitlles@vhebron.net.
authors.forename: Marc
authors.initials: M
authors.lastname: Miravitlles
authors.forename: Cayo
authors.initials: C
authors.lastname: García-Polo
authors.forename: Adolfo
authors.initials: A
authors.lastname: Domenech
authors.forename: Gustavo
authors.initials: G
authors.lastname: Villegas
authors.forename: Francisco
authors.initials: F
authors.lastname: Conget
authors.forename: Cristian
authors.initials: C
authors.lastname: de la Roza
mesh_terms: D000368:Aged; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000191:economics / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use*; D001372:Aza Compounds / Q000191:economics / Q000627:therapeutic use; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D005260:Female; D024841:Fluoroquinolones; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000502:physiology; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077266:Moxifloxacin; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000191:economics* / Q000503:physiopathology; D011804:Quinolines / Q000191:economics / Q000627:therapeutic use; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D019980:Amoxicillin-Potassium Clavulanate Combination; D000077266:Moxifloxacin