PURPOSE: The purpose of this study was to identify and characterize community acquired pneumonia (CAP) episodes by the initiating antibiotic.
METHODS: The sample consists of persons over age 18 from the Marketscan claims databases from 2000-2003. We identified CAP episodes for patients with claims for ICD9 codes 481.XX-486.XX (n=1,447). Initiating antibiotics were identified via the NDC code in each episode. The costs came from the claims data.
RESULTS: The most common initial antibiotic treatments for CAP were azithromycin (27%), levofloxacin (23%), clarithromycin (21%), cefuroxime (13%), amoxicillin (7%), gatifloxacin (6%), and a group of all other antibiotics (13%). Patients with a CAP episode had a mean age of 41, were most commonly enrolled in a capitated HMP/POS plan and most were male (55%). The mean Charlson Comorbidity Index of all patients with an episode was 0.18, with the highest in the cefuroxime group (0.47) and the lowest in the levofloxacin group (0.12), indicating an overall health differential in patients across the antibiotic treatments. Mean length of an episode was 10 days overall; the highest was in the cefuroxime group (16 days). Health care utilization showed most episodes were associated with a physician visit (96%) and/or a diagnostic test (56%). Among all episodes, 15% of patients had an emergency room visit for CAP. The highest expenditure for CAP episodes was inpatient care (mean $11,160 among persons with an admission).
CONCLUSION: The results of this retrospective descriptive analysis showed considerable variation not only in patient characteristics, but also in expenditures between CAP episodes by initiating antibiotic treatment.
CLINICAL IMPLICATIONS: Most of the episodes were treated by a small group of antibiotics indicating a narrow practice pattern of pharmacologic treatment for CAP.
DISCLOSURE: Carl Asche, None.