Levofloxacin Pharmacoeconomics and Route of Administration

During the POS and PCP, 49 and 82 cases respectively received IV levofloxacin. No significant differences in age, gender, or infection type were observed between groups. The majority of infections during both periods were community-acquired pneumonia, followed by complicated UTIs. All patients received a 500 mg dose of levofloxacin once daily for the entire treatment duration, including those treated for complicated UTIs.

Out of the 131 patients, 30 in the POS and 53 in the PCP met conversion criteria while receiving levofloxacin treatment (p = 0.827). No significant differences in age, gender, or infection types were found between these subpopulations. Most patients eligible for conversion to oral treatment had community-acquired pneumonia.

Comparison of Treatment Periods

Patients meeting conversion criteria in both the POS and PCP periods had similar demographics. The mean day of eligibility for conversion was comparable between the two groups, although a significantly higher number of patients in the PCP were converted to oral treatment (p = 0.009). On average, PCP patients were converted to oral therapy 3.4 days earlier. Four patients in the PCP group did not have their treatment converted due to weekends or holiday interruptions, but IV levofloxacin was discontinued before the pharmacist could convert to oral therapy. The median length of stay was significantly shorter for conversion candidates in the PCP compared to the POS group (p = 0.031).

Oral Treatment Success

During the PCP, two patients required reconversion to IV therapy. Neither reconversion was due to failure of the oral regimen. One patient suffered a stroke three days post-conversion and required a feeding tube, while the second was readmitted to the ICU for non-infection-related complications. Both were subsequently switched back to IV therapy.

Of the 53 patients eligible for oral conversion, 30 were clinically evaluable. Most of these patients (60%) had community-acquired pneumonia; other conditions included six complicated UTIs, two skin infections, and individual cases of meningitis, urosepsis, MRSA, and cholangitis. The primary reason for non-evaluability was the presence of confounding factors that complicated the diagnosis. All 30 clinically evaluable patients were available for follow-up within two weeks after discontinuation of levofloxacin. The clinical success rate was 100%, with no adverse events reported in either group related to IV or oral levofloxacin treatment.

Cost Analysis

According to the 16 interventions documented by pharmacists, the average time spent identifying and converting IV levofloxacin to oral therapy was 9 minutes (range: 1–20 minutes), resulting in an additional cost of $5.10 per patient during the PCP. Nursing costs associated with administering and monitoring IV levofloxacin amounted to $0.83 per dose.

For patients who met conversion criteria, costs at all levels were significantly lower during the PCP compared to the POS. The most notable difference was in level-3 care, where savings of approximately $3,300 per patient were realized. In the intention-to-treat analysis, only level-1 costs were significantly lower for the PCP, while level-2 costs were non-significantly lower.

Pharmacoeconomic Analysis of Antihypertensive Medication Persistence

Study Population and Methodology

An aggregate of 19,995 subjects were taken on the review. Of these, 5933 subjects (29.7% of enrollees) were excluded: 3673 (18.4% of enrollees) because they were taking a class of medication excluded from the review, 1443 (7.2% of enrollees) due to joining several medication classes, 480 (2.4% of enrollees) due to death, and 337 (1.7% of enrollees) because they moved away during the follow-up period.

A total of 14,062 patients were included in the study, 6098 men (43.4%) and 7964 women (56.6%) with a mean age of 56.9±17.7 years (range 20-105 years). ACE inhibitors were the most commonly prescribed medication (28.0%), followed by CCBs (23.8%), diuretics (23.8%), β-blockers (17.6%), and AIIAs (6.9%).

Treatment Persistence Results

Within the population, 60.3% of patients discontinued treatment, 30.9% continued treatment, and 8.8% switched treatment. Among those who discontinued, 83.3% interrupted the treatment after a single prescription. Among the continuers, 81.1% maintained their enrollment treatment throughout the follow-up period without switching. The rates of continuers, switchers, and discontinuers varied significantly among the five medication classes (p<0.001).

Persistence with therapy was related to age (each year of age decreased the risk of discontinuation by 2.2%), coronary heart disease or diabetes (subjects not treated for these showed a higher risk of stopping), hospitalization history for cardiovascular disease, comorbidities, and the antihypertensive class prescribed at enrollment.

Patients starting on AIIAs were more likely to remain on treatment compared to those on ACE inhibitors (38.6% higher discontinuation risk), CCBs (66.3% higher risk), and diuretics (85.3% higher risk). Gender and the use of anti-asthmatic drugs were not significantly associated with treatment persistence.

Cost Analysis Findings

The total cost for the study cohort was €1,238,752.37, of which €745,328.31 was for continuers (60.2%), €253,293.08 for switchers (20.4%), and €240,130.98 for discontinuers (19.4%). The average yearly cost per patient was €88.09 (95% CI, €86.10–€90.08). The cost varied significantly based on the medication class and persistence patterns (p<0.001).

The annual cost of antihypertensive treatment was associated with age (each year reduced the cost by €0.43), persistence patterns (switchers incurred €33.17 higher costs than continuers), and the number of drug classes prescribed (each additional class increased the cost by €10.94).

Patients who began treatment with diuretics had lower annual costs compared to those starting on β-blockers (€67.45 more), ACE inhibitors (€168.20 more), CCBs (€188.84 more), and AIIAs (€278.19 more).

Managing Rising Healthcare Costs for Your Business

Providing employees with health insurance coverage continues to increase at a double-digit rate. A lot about cost drivers in health care exorbitant hospital charges, rising prescription drug costs, expenses associated with developing new technologies and treatments, an aging population and litigation. Nurturing these factors is an environment in which the demand for health care seems to be increasing.

For the most part, there is little employers can do to control what is driving health care costs out of their reach. Health benefits companies can and do negotiate discounts, and while those help, the underlying costs continue to skyrocket. The increases created by these cost drivers flow through the health benefits companies and eventually trickle down to employers in the form of higher health insurance premiums.

In this soft economy, declining revenue is putting a squeeze on company expenses. It is likely that you will experience a 15 percent to 20 percent increase in your group health insurance when a renewal form lands on your desk.

Can you raise the cost of your company's product or service as quickly as your health insurance premiums are increasing?
Probably not. However, there are steps you can take to gain some control over your health care costs.

Finding a solution

Employers can exercise some control over their costs by finding a health benefits company that provides the "best" value for their company's premium dollars. The way in which you "shop" a health plan can impact the price. I'll use an analogy. Your travel agent has a great deal for you - air, car, hotel and meals included. You tell your agent to book it.

Coincidently, your neighbors just booked that same trip for $1,000 less through their travel agent. One agent shopped for the best price, the other agent arranged the trip through his or her vendor of choice. Whether it's a family vacation, buying a car or choosing a health benefits plan, how you shop can impact your cost. Make sure your insurance agent doesn't "arrange" your health plan for you. How many providers are enough? The more participating providers a health plan has, the more you're likely to pay in premiums. If you are considering a health plan that doesn't include a few desired physicians, request that the carrier add them to its network.

Physicians participate in many different health plans and are usually willing to participate in one more. Don't get caught in the trap of paying 10 percent to 15 percent more for your health insurance premiums because one or two doctors are not participating in the plan. It's reasonable that an employee can find another physician out of the thousands on the plan.

The power of marketing

Living in the United States affords us exceptional opportunities and choices. Along with that privilege comes a barrage of communications designed to influence our decision-making. What we read in the papers, see on television, hear on the radio, see flashed across a billboard, get stuffed in our mailboxes or pops up on the Internet is designed to predispose us to a company or its product.

Marketing can be an effective tool, and depending on how much is spent, can be quite influential. What marketing cannot do, however, no matter how much is spent, is replace what it takes to come up with an affordable health benefits solution that works for you. Be sure to look for a health benefits company that is flexible, listens and is willing to roll up its sleeves to provide you with a package of health benefits that you can afford.