Active substance: Doxycycline
Two retrospective studies and one randomised controlled trial suggested that antibiotics prolong time to the next exacerbation.
However, evidence on the cost-effectiveness of antibiotics for the treatment of COPD exacerbations in an outpatient setting is scarce. Recently, a randomised controlled trial conducted by the current research group investigated the long-term clinical effectiveness of doxycycline versus placebo added to prednisolone for the treatment of COPD exacerbations in an outpatient setting.
Differently from what it was hypothesised, it found that treatment with antibiotics did not prolong time to the next exacerbation. However, the randomised controlled trial could not exclude the possibility that short-term treatment nonresponse was lower in patients treated with antibiotics, which might result in lower total costs in this group.
Hence, despite not being clinically effective, treatment with doxycycline might still be cost-effective.
To assess whether this was the case, we conducted a cost-effectiveness analysis alongside the previously reported randomised controlled trial, the results of which are presented here.
This was a randomised, double-blind, controlled trial investigating the long-term clinical and cost-effectiveness of doxycycline plus prednisolone versus placebo plus prednisolone for the treatment of COPD exacerbations in an outpatient setting.
The trial protocol was approved by the ethics committee of the Academic Medical Centre at the University of Amsterdam, and patients gave their written informed consent. Participants, investigators and those assessing outcomes were blinded to intervention assignment.
Full details of the trial are available in Van Velzen et al. Participants Participants were recruited from nine teaching hospitals and three primary care practices in The Netherlands.
All patients entered a prospective cohort. If further exacerbations occurred during the 2-year follow-up period, patients received the same medications as by treatment allocation.We assessed the effectiveness of doxycycline and azithromycin for the treatment of rectal and vaginal chlamydia in women clinic, but it remains unclear what.
Procedures Baseline data, including demographics, GOLD stage, smoking history and medication use, were collected at the time of inclusion in the prospective cohort and recorded in a standardised electronic case record form eCRF, Oracle Clinical.
The questionnaire self-reported health status ranges from 11111 no problems in any of the five dimensions to 33333 extreme problems in all the five dimensions.
The VAS ranges from 0 worst imaginable health to 100 best imaginable health.
Given the societal perspective employed in this economic evaluation, all-cause resource use was collected. Each patient self-reported hospitalisation was verified by contacting the hospital where hospitalisation took place and requesting a hospital discharge letter.
Healthcare costs included intervention costs. Patient and family costs included informal care and unpaid help. Costs were estimated multiplying the units of resource use by their standard cost according to the Dutch guidelines for economic evaluation.