Acute exacerbation of chronic bronchitis: Disease-specific issues that influence the cost-effectiveness of antimicrobial therapy

Background: Acute exacerbation of chronic bronchitis (AECB) is a common con dition, with substantial associated costs and morbidity. Research efforts h ave focused on innovations that will reduce the morbidity associated with A ECB. Health care payers increasingly expect that the results of evidence-ba sed economic evaluations will guide practitioners in their choice of cost-e ffective interventions. Objectives: To provide a framework on which to base effective and efficient antimicrobial therapy for AECB, we present a concise clinical review of AE CB, followed by an assessment of the available data on the economic impact of this disease. We then address several AECB-specific issues that must be considered in cost-effectiveness analyses of AECB antimicrobial interventio ns. Methods: Published literature on the clinical and economic impact of AECB w as identified using MEDLINE (R), pre-MEDLINE (R), HealthSTAR, CINAHL, Curre nt Contents/All Editions, EMBASE, and International Pharmaceutical Abstract s databases. Other potential sources were identified by searching for refer ences in retrieved articles, review articles, consensus statements, and art icles written by selected authorities. Results: In evaluating cost-effectiveness analyses of AECB antimicrobial th erapy it is critical to (1) use the disease-free interval as an outcome mea sure, (2) evaluate the sequence of multiple therapies, (3) address the impa ct of both current and future antibiotic resistance, and (4) measure ail ap propriate AECB-associated costs, both direct and indirect. Conclusions: Incorporating these approaches in economic analyses of AECB an timicrobial therapy can help health care organizations make evidence-based decisions regarding the cost-effective management of AECB.