Highlights
-
Pulmonary exacerbations are clinically debilitating and expensive to treat.
-
Ideal duration of treatment with antimicrobial medication is unknown.
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Clinical outcomes (lung function) were similar between treatment duration groups.
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Thirty-day costs were lower in groups that were randomized to receive IV treatment for shorter durations.
Abstract
Background
The purpose of these analyses was to determine whether overall costs were reduced
in cystic fibrosis (CF) patients experiencing pulmonary exacerbation (PEx) who received
shorter versus longer durations of treatment.
Methods
Among people with CF experiencing PEx, we calculated 30-day inpatient, outpatient,
emergency room, and medication costs and summed these to derive total costs in 2020
USD. Using the Kaplan-Meier sample average (KMSA) method, we calculated adjusted costs
and differences in costs within two pairs of randomized groups: early robust responders
(ERR) randomized to receive treatment for 10 days (ERR-10 days) or 14 days (ERR-14
days), and non-early robust responders (NERR) randomized to receive treatment for
14 days (NERR-14 days) or 21 days (NERR-21 days).
Results
Patients in the shorter treatment duration groups had shorter lengths of stay per
hospitalization (mean ± standard deviation (SD) for ERR-10 days: 7.9 ± 3.0 days per
hospitalization compared to 10.1 ± 4.2 days in ERR-14 days; for NERR-14 days: 8.7 ± 4.9
days per hospitalization compared to 9.6 ± 6.5 days in NERR-21 days). We found statistically
significantly lower adjusted mean costs (95% confidence interval) among those who
were randomized to receive shorter treatment durations (ERR-10 days: $60,800 ($59,150
- $62,430) vs $74,420 ($72,610 - $76,450) in ERR-14 days; NERR-14 days: $66,690 ($65,960-$67,400)
versus $74,830 ($73,980-$75,650) in NERR-21 days).
Conclusions
Tied with earlier evidence that shorter treatment duration was not associated with
worse clinical outcomes, our analyses indicate that treating with shorter antimicrobial
durations can reduce costs without diminishing clinical outcomes.
Keywords
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Article info
Publication history
Published online: March 14, 2022
Accepted:
March 6,
2022
Received in revised form:
March 1,
2022
Received:
October 8,
2021
Identification
Copyright
© 2022 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.
