Health economic analyses of current management of patients hospitalized with community-acquired pneumonia In Europe (2010-2011) : (Retrospective study to asess the clinical management of patients with moderate-to-Severe CSSTI Or CAP infections In the hospital setting [REACH]) : use of resources and consequences of treatment failure Read More: http://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2012.185.1_MeetingAbstracts.A2579

Introduction: Community-acquired pneumonia (CAP) is associated with substantial economic burden to health care systems, especially when hospitalization is required. The REACH study (NCT01293435) aimed to provide reliable data on current burden and clinical management of CAP in hospitals across Europe, thus gaining an insight into how clinical outcomes affect economic burden. Presented here are the health economic analyses of the study data. Methods: REACH was a multinational, multicentre, observational, retrospective study of patients ≥18 years old hospitalized with CAP requiring treatment with intravenous antibiotics. Variables collected via electronic Case Report Forms included patient demographics, medical history, disease characteristics and severity (PORT/PSI, CURB-65), microbiological diagnosis, treatments before and during hospitalization and health resource consumption. Results: Mean duration of hospital stay for the population (N=2039) was 12.6 days (median: 10.0). Mean duration of stay in patients admitted to ICU was 9.5 days (median: 5.0) (n=278). Hospital stay and resource use for patients with a recurrent infection or septic shock versus those without either are shown in Table 1. Patients with treatment failure (n=757), defined as a need for antibiotic change, had longer mean duration of hospital stay including more frequent, longer mean admissions to ICU than patients without failure. Patients with treatment failure were also more likely to develop septic shock and had higher requirements for additional hospital resources such as mechanical ventilation, parenteral nutrition, blood pressure support and renal replacement. Patients re-hospitalized after initial discharge (recurrence) had an increased risk of treatment failure compared with patients presenting with their first infection (42.6%; n=40 vs 31.8%; n=492), longer time to clinical stability (6.8 vs 5.4 days) and longer hospital stay (13.7 vs 11.5 days). Patients developing septic shock (n=84) experienced longer hospital stays and required more hospital resources. No meaningful differences in duration of stay were observed between patients with healthcare-associated pneumonia (HCAP; n=235) and those with CAP only (n=1558) (12.6 vs 11.8 days). However, ICU admissions were shorter in HCAP patients than in CAP patients (5.2 vs 9.9 days). Immunosuppression, though rare, placed a substantial burden on hospital resources. Overall mortality rate was 7.2% (n=147). Conclusions: The REACH study demonstrated that treatment failure is common in CAP and HCAP patients in hospitals in Europe, and results in a considerable burden of increased length of stay and increased need for additional support. Identifying susceptible patients and improving initial antibiotic therapy is likely to improve outcomes and reduce hospital resource use.