Last Resort Antibiotics Costs and Reimbursement Analysis of Real-Life ICU Patients with Pneumonia Caused by Multidrug-Resistant Gram-Negative Bacteria in Germany

被引:4
作者
Jeck, Julia [1 ,2 ,3 ]
Wingen-Heimann, Sebastian M. [2 ,3 ,4 ]
Jakobs, Florian [5 ,6 ]
Franz, Jennifer [1 ,2 ,3 ,7 ]
Baltin, Christoph T. [1 ,3 ,4 ,8 ]
Kron, Anna [1 ,2 ,3 ,7 ,9 ]
Boell, Boris [2 ,3 ]
Kochanek, Matthias [2 ,3 ,7 ]
Cornely, Oliver A. [2 ,3 ,7 ,10 ,11 ,12 ]
Kron, Florian [1 ,2 ,3 ,4 ,7 ]
机构
[1] VITIS Healthcare Grp, Morsdorfer Hof 12, D-50933 Cologne, Germany
[2] Univ Cologne, Fac Med, Dept Internal Med 1, Kerpener Str 62, D-50937 Cologne, Germany
[3] Univ Cologne, Univ Hosp Cologne, Kerpener Str 62, D-50937 Cologne, Germany
[4] FOM Univ Appl Sci, KCM KompetenzCtr Medizinoekon, Herkulesstr 32, D-45127 Essen, Germany
[5] Univ Duisburg Essen, Fac Med, Dept Haematol & Stem Cell Transplantat, Hufelandstr 55, D-45147 Essen, Germany
[6] Univ Duisburg Essen, Essen Univ Hosp, Hufelandstr 55, D-45147 Essen, Germany
[7] Univ Cologne, Fac Med, Ctr Integrated Oncol CIO ABCD, Kerpener Str 62, D-50937 Cologne, Germany
[8] Univ Cologne, Fac Med, Dept Orthoped & Trauma Surg, Kerpener Str 62, D-50937 Cologne, Germany
[9] Univ Hosp Cologne, Natl Network Genom Med Lung Canc, Kerpener Str 62, D-50937 Cologne, Germany
[10] Univ Cologne, Fac Med, Clin Trials Ctr Cologne ZKS Koln, Gleueler Str 269, D-50935 Cologne, Germany
[11] Univ Cologne, Fac Med, Cologne Excellence Cluster Cellular Stress Respon, Translat Res, Joseph Stelzmann Str 26, D-50931 Cologne, Germany
[12] Univ Cologne, Fac Med, Excellence Ctr Med Mycol ECMM, Kerpener Str 62, D-50937 Cologne, Germany
关键词
last resort antibiotics; reimbursement; multidrug-resistant Gram-negative bacteria; MDR-GNB;
D O I
10.3390/healthcare10122546
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Multidrug-resistant Gram-negative bacteria (MDR-GNB) cause serious infections and aggravate disease progression. Last resort antibiotics are effective against MDR-GNB and are reimbursed by flat rates based on German diagnosis-related groups (G-DRG). From a hospital management perspective, this analysis compared hospital reimbursement for last resort antibiotics with their acquisition costs to outline potential funding gaps. Retrospective analyses based on medical charts and real-life reimbursement data included patients with pneumonia due to MDR-GNB treated in intensive care units (ICU) of a German tertiary care hospital (University Hospital Cologne) between January 2017 and December 2020. Drug-associated hospital reimbursement of G-DRG was compared with drug acquisition costs based on preliminarily approved last resort antibiotics (cefiderocol, ceftazidime-avibactam, ceftolozane-tazobactam, and imipenem-cilastatin-relebactam) according to label. Funding gaps were determined for the treatment of Enterobacterales, Pseudomonas aeruginosa, Acinetobacter baumannii, and mixed infections, respectively. Most of the 31 patients were infected with Enterobacterales (n = 15; 48.4%) and P. aeruginosa (n = 13; 41.9%). Drug-associated G-DRG reimbursement varied from 44.50 EUR (mixed infection of P. aeruginosa and Enterobacterales) to 2265.27 EUR (P. aeruginosa; mixed infection of P. aeruginosa and Enterobacterales). Drug acquisition costs ranged from 3284.40 EUR in ceftazidime-avibactam (minimum duration) to 15,827.01 EUR for imipenem-cilastatin-relebactam (maximum duration). Underfunding was found for all MDR-GNB, reaching from 1019.13 EUR (P. aeruginosa; mixed infection of P. aeruginosa and Enterobacterales) to 14,591.24 EUR (Enterobacterales). This analysis revealed the underfunding of last resort antibiotics in German hospital treatment. Insufficient reimbursement implies less research in this field, leading to a more frequent use of inappropriate antibiotics. The cycle closes as this contributes to the development of multi-drug resistant bacteria.
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页数:10
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