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A new study is the first to quantify the impact of acute exacerbations of chronic bronchitis (AECB) and its treatment on the cost of lost work productivity, based on patients’ own assessments of impairment attributable to the disorder while on the job. The report shows that, when used for the treatment of AECB, the fluoroquinolone antibiotic moxifloxacin HCl (Avelox) resulted in less impairment of work productivity and may result in greater cost savings compared to treatment with levofloxacin HCl (Levaquin). This study was supported through an educational grant from the Bayer Corp., manufacturer of moxifloxacin (Avelox).
Eleanor Perfetto, PhD, chief operating officer for Quality Metrics in Lincoln, RI, and co-author of the study, says the research provides more specific information on the workplace impact of chronic bronchitis than previous studies. "Past studies have shown that AECB is responsible for a great deal of workplace costs related to absenteeism," Perfetto says. "Our study showed that AECB also impairs productivity in the workplace; however, patients reported less impairment during an episode of AECB when they were treated with Avelox than with Levaquin. Because impaired work productivity is costly for employers, our findings suggest that insurers and employers should consider such costs, in addition to direct medical expenses, when making formulary decisions."
Perfetto says that although other studies have examined the effect of antibiotic therapy for AECB and other respiratory illnesses on various indicators of work productivity, such as absenteeism, this study was the first to also quantify reduced work productivity based on patients’ subjective assessments of work impairment caused by AECB, and include it in the estimation of indirect, work-related costs.
She says the data for the study were drawn from a previously completed clinical trial, and indirect costs were estimated based on national wage averages. The findings were part of a randomized, double-blind clinical study that compared the safety and efficacy of moxifloxacin 400 mg daily for five days to levofloxacin 500 mg daily for seven days, in the treatment of AECB.
The two treatments were found to be equivalent in terms of clinical efficacy; the findings published in Managed Care Interface focus on the indirect costs of lost work time and lowered work productivity. Of 192 patients with confirmed AECB who were valid for analysis and who reported working for pay, 91 were randomly assigned to receive moxifloxacin and 101 received levofloxacin. Lost work time and lowered work productivity were assessed for two time periods:
Patients were asked how many hours they missed from work because of AECB and other reasons; how many hours they worked during the study; and about their subjective assessment of the degree of impairment AECB caused them while working, on a scale of 0 to 10 (0 = AECB had very little effect, and 10 = AECB prevented them from working).
The effect of AECB and treatment on productivity, expressed as indirect workplace costs, was calculated based on the amount of work time affected, the degree of impairment, and national averages for hourly wages.
At visit two, patients in the moxifloxacin group reported significantly less impairment during the time between visits one and two than did patients in the levofloxacin group: a median of 3 vs. 5 on the 0-10 scale, respectively. These impairment rates applied to an average total of 61.3 and 60.2 work hours for each patient in the moxifloxacin and levofloxacin groups, respectively, between the two visits. Impairment rates between visits two and three were not significantly different. There were no significant differences between the two groups in the time missed from work between visit one and visit two, or between visit two and visit three.
Josephine Li-McLeod, PhD, associate director of health economics and outcomes research at Bayer Corp., was a co-author of the study. She says the study confirms some benefits that the manufacturer had suspected. "Our finding that patients in the Avelox group reported less impairment in the early part of the study — between visits one and two — suggests they felt better faster, and is consistent with past anecdotal reports on Avelox," Li-McLeod says.
Researchers estimated that the average cost of reduced productivity for each AECB episode was one-quarter less for the moxifloxacin group compared with the levofloxacin group: $733 vs. $975, respectively, a difference of approximately $242. Because patients with chronic bronchitis suffer an average of three AECB episodes per year, the cost difference per patient per year would be about $726. "These kinds of cost advantages can make a big difference to an employer or a managed care organization," Perfetto says.
She also notes that the published direct cost of moxifloxacin is approximately $44 for its recommended five-day course of AECB therapy, compared with approximately $60 for the seven-day regimen of levofloxacin. "Based on both the direct medical costs and indirect costs of lost productivity, Avelox would appear to be a better choice," she says.
Perfetto cautioned that the study was exploratory and based on data from one clinical trial and those findings need to be confirmed by additional research.