Üniversite Hastanesi ve Devlet Hastanesi'nde İzlenen Kronik Obtrüktif Akciğer Hastalığı Olan Hastaların Karşılaştırılması

Abstract

Amaç: Kronik Obstrüktif Akciğer Hastalığı (KOAH) önemli bir mortalite ve morbidite nedenidir ve ülke ekonomilerine ciddi yükler getirmektedir. Devlet ve üniversite hastanelesinde, KOAH alevlenmesi tanısı ile yatırılan hastalarda KOAH'ın ekonomik yükünü etkileyebilecek muayene, tedavi ve yaklaşım farklılıklarını inceledik. Gereç ve Yöntemler: Üniversite hastanesinde(ÜH) tedavi gören 104 hasta ile Devlet Hastanesinde(SH) KOAH nedeniyle tedavi gören 102 hasta çalışmaya dahil edildi.İki hastane arasındaki hekimlerin yaklaşım ve maliyet analizleri karşılaştırıldı. Bulgular ve Sonuç: SH'de yaş ortalaması daha yüksekti(p=0,01). UH'de komorbiditeler daha yüksekti(p<0,001).UH'de nebulizer tedavisi alan hasta sayısı(p=0,02) ve toplam sayı kullanılan nebulizatör ilaç miktarı SH'de daha yüksekti(p<0,001). İntravenöz(IV) ilaç kullanılan hasta sayısı ve kullanılan toplam IV ilaç sayısı SH'de daha yüksekti(p<0,001).Toplam İM sayısı UH'de daha fazlaydı(p<0,001). UH'de kullanılan oral antibiyotik sayısı daha fazlaydı(p<0,001).UH'li hastalarda penisilinler,makrolidler,penisilin-makrolitler daha fazla kullanıldı.Sefalosporinler ve kinolonlar SH'de daha fazla kullanıldı (p<0,001). SH'de inhaler kortikosteroid(ICS)(p<0,001), nebulizer formda salbutamol+ipratropiumbromur kombinasyonu(p<0,001) ve daha fazla hastada IV teofilin kullanıldı(p=0,01). UH'de nebulizer formda salbutamol kullanımı daha fazlaydı(p<0,001).Spirometri,arter kan gazı analizi(sırasıyla p<0,001,p<0,001),akciğer grafisi UH'de daha fazla yapıldı(p=0,02).Toplam maliyet(p<0,001),toplam ve günlük ilaç maliyetleri SH'de daha fazlaydı(p<0,001).UH'de ilaç dışı maliyetler daha fazlaydı(p=0,02). KOAH alevlenmesi ile hastaneye yatırılan hastalarda maliyet üzerine kılavuzlara uyumun çok önemli bir etkisi olduğuna inanıyoruz.

Keywords

• KOAH
• devlet hastanesi
• ekonomik yük
• ilaç
• üniversite hastanesi

Comparison of Patients with Chronic Obstructive Pulmonary Disease that Hospitalized in University Hospital and State Hospital

Abstract

Aim:Chronic Obstructive Pulmonary Disease(COPD) is an important mortality and morbidity reason and brings serious burdens to the economies of countries.We analyzed differences in examination,treatment and approach that may affect the economic burden of COPD in hospitalized patients with a diagnosis of COPD exacerbation in state and university hospitals Material and Methods:104 patients who were being treated in university hospital(UH) and 102 patients in State Hospital(SH) because of COPD were included.The difference in approach of physicians and cost analysis between two hospitals were compared Results and Conslusion:The average age was higher in SH(p=0,01).Comorbities were higher in UH(p<0.001).The number of patients who received nebulizer treatment(p=0,02) in UH and total number of nebulizer medication used was higher in SH(p<0,001).The number of patients for whom intravenous(IV) medication was used and the number of total IV medication used was higher in SH(p<0,001).The total number of IM medication used was higher in UH(p<0,001).The number oral antibiotics used was higher in UH(p<0,001).The penicillins,macrolids,penicillin-macrolids were used more in patients in UH.The cephalosporins and quinolons were used more in SH(p<0,001).Inhaler corticosteroid(ICS)(p<0,001),salbutamol+ipratropiumbromur combination in nebulizer form(p<0,001) and IV teophilin was used in more patients in SH(p=0,01).The use of salbutamol in nebulizer form was more in UH(p<0,001).Spirometry,arterial blood gas analysis(respectively p<0,001,p<0,001),chest radiography was applied more in UH(p=0,02).Total cost(p<0,001),total and daily medication costs was more in SH(p<0,001).Costs other than medication was more in UH(p=0,02).We believe that adherence to the guidelines has a very important effect on cost in patients hospitalized with COPD exacerbation

Keywords

• COPD
• drug
• economic burden
• state hospital
• university hospital

References

1. [1] Fogazzi GB, Verdesca, S., & Garigali, G. . Urinalysis: Core Curriculum 2008. American Journal of Kidney Diseases, (2008). :1052-67. https://doi.org/10.3/j.ajkd.2007.11.039.
2. [2] Guarascio AJ, Ray SM, Finch CK, Self TH. The clinical and economic burden of chronic obstructive pulmonary disease in the USA. ClinicoEconomics and outcomes research : CEOR 2013;5:235-45.
3. [3] Starkie HJ, Briggs AH, Chambers MG. Pharmacoeconomics in COPD: lessons for the future. International journal of chronic obstructive pulmonary disease 2008;3:71-88.
4. [4] Wouters EF. Economic analysis of the Confronting COPD survey: an overview of results. Respiratory medicine 2003;97 Suppl C:S3-14.
5. [5] Mapel DW, Roberts MH. New clinical insights into chronic obstructive pulmonary disease and their implications for pharmacoeconomic analyses. PharmacoEconomics 2012;30:869-85.
6. [6] Skrepnek GH, Skrepnek SV. Epidemiology, clinical and economic burden, and natural history of chronic obstructive pulmonary disease and asthma. The American journal of managed care 2004;10:S129-38.
7. [7] Oostenbrink JB, Rutten-van Mölken MP, Al MJ, Van Noord JA, Vincken W. One-year cost-effectiveness of tiotropium versus ipratropium to treat chronic obstructive pulmonary disease. The European respiratory journal 2004;23:241-9.
8. [8] Stâmbu I, Stoicescu IP. [Estimation of direct medical costs of chronic obstructive pulmonary disease over 12 months]. Pneumologia (Bucharest, Romania) 2013;62:86-92.

9. [9] Nie JX, Wang L, Upshur RE. Mortality of elderly patients in Ontario after hospital admission for chronic obstructive pulmonary disease. Canadian respiratory journal 2007;14:485-9.
10. [10] Ozkaya S, Findik S, Atici AG. The costs of hospitalization in patients with acute exacerbation of chronic obstructive pulmonary disease. ClinicoEconomics and outcomes research : CEOR 2011;3:15-8.
11. [11] al VYe. The Cost of COPD Exacerbations Managed in Hospital. Turk Toraks Derg 2013:14: 9-23.
12. [12] Deniz S, Şengül A, Aydemir Y, Çeldir Emre J, Özhan MH. Clinical factors and comorbidities affecting the cost of hospital-treated COPD. International journal of chronic obstructive pulmonary disease 2016;11:3023-30.
13. [13] Torabipour A, Hakim A, Ahmadi Angali K, Dolatshah M, Yusofzadeh M. Cost Analysis of Hospitalized Patients with Chronic Obstructive Pulmonary Disease: A State-Level Cross-Sectional Study. Tanaffos 2016;15:75-82.
14. [14] http://action.lung.org/site/DocServer/lung-disease-data-2008-report.pdf
15. [15] Almagro P, Rodríguez-Carballeira M, Tun Chang K, Romaní V, Estrada C, Barreiro B, et al. [Hospitalizations due to chronic obstructive pulmonary disease in the elderly]. Revista espanola de geriatria y gerontologia 2009;44:73-8. [16] Kitabevi 2010;1:663-734. PMKEvRFEÖTMMKMKASSvHTBKCİT.
16. [17] Turner MO, Patel A, Ginsburg S, FitzGerald JM. Bronchodilator delivery in acute airflow obstruction. A meta-analysis. Archives of internal medicine 1997;157:1736-44.
17. [18] Mannino DM, Thorn D, Swensen A, Holguin F. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. The European respiratory journal 2008;32:962-9.
18. [19] Curkendall SM, DeLuise C, Jones JK, Lanes S, Stang MR, Goehring E, Jr., et al. Cardiovascular disease in patients with chronic obstructive pulmonary disease, Saskatchewan Canada cardiovascular disease in COPD patients. Annals of epidemiology 2006;16:63-70.
19. [20] Ram FS, Rodriguez-Roisin R, Granados-Navarrete A, Garcia-Aymerich J, Barnes NC. Antibiotics for exacerbations of chronic obstructive pulmonary disease. The Cochrane database of systematic reviews 2006:Cd004403.
20. [21] Calverley PM, Anderson JA, Celli B, Ferguson GT, Jenkins C, Jones PW, et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. The New England journal of medicine 2007;356:775-89.
21. [22] Gartlehner G, Hansen RA, Carson SS, Lohr KN. Efficacy and safety of inhaled corticosteroids in patients with COPD: a systematic review and meta-analysis of health outcomes. Annals of family medicine 2006;4:253-62.
22. [23] Janson C, Larsson K, Lisspers KH, Ställberg B, Stratelis G, Goike H, et al. Pneumonia and pneumonia related mortality in patients with COPD treated with fixed combinations of inhaled corticosteroid and long acting β2 agonist: observational matched cohort study (PATHOS). BMJ (Clinical research ed) 2013;346:f3306.
23. [24] Burge PS. Occupation and chronic obstructive pulmonary disease (COPD). The European respiratory journal 1994;7:1032-4.
24. [25] Wise R, Connett J, Weinmann G, Scanlon P, Skeans M. Effect of inhaled triamcinolone on the decline in pulmonary function in chronic obstructive pulmonary disease. The New England journal of medicine 2000;343:1902-9.