INCREASED MORBIDITY AND HIGH COST OF THERAPY AS A CONSEQUENCE OF CURRENT TREND OF COMMUNITY-ACQUIRED PNEUMONIA TREATMENT IN KARACHI

In an era of expanding health sectors and rising costs, doctors are expected to have a working knowledge of health economics to better use resources and improve outcomes and quality of health care. One of the basic rights of every individual is to enjoy "the highest desirable quality of health". Achieving better health requires not only adequate medical knowledge and technologies, laws and social measures in the field of health care, but also sufficient funding for fulfilling people's right to health. However, the economic crisis has left every community with limited possibility of investing in health care and forced them to use the available resources more efficiently. The increasing cost of disease and unsuitable health care systems are being compounded by the persistent economic losses. The rising costs of health care and, in particular, prescription drugs remain a challenge. The economic load of Commmunity acquired pneumonia(CAP) makes it an important community health issue, particularly for children and the elderly. Physicians must weigh their obligation to provide their patients with the best care possible against their obligation to be good stewards of health care resources. Community-acquired pneumonia (CAP) is the most important reason of mortality in the category of respiratory diseases in the modern world further; it is associated with a high economic burden. Researchers have therefore sought ways to improve CAP outcomes while reducing costs. It is important to have an understanding of the cost and disease burden of pneumonia in the community to help evaluate future prevention efforts. Utilization of guideline concordant treatment altersthe advancement of resistance, declines health service expenses, and decreases morbidity and mortality.In the present study the main objective of the study was to determine the current trend of management of CAP patients and the direct cost of treatment in patients hospitalized due to CAP both in adults and children with community acquired pneumonia. The present study consists of two parts in the 1st part of the study the trend of treatment of community acquired pneumonia through the different specialties of doctors including (General practitioners, General Physicians, Residence medical officers, Pediatricians and chest specialists) was determined by means of a Questionnaire.A total of 550 questionnaire were distributed but questionnaire was filled by 500 doctors.There was 91% response rate. Questionnaire mainly consists of questions related to the current trend and practices of treatment of CAP in an outpatient setting. In the second part of the study the treatment pattern was determined in CAP patients hospitalized due to CAP in three private hospitalsand in a public hospital.The population of the study consists of 514 patients were included from the three private hospitals and 286 patients were included from the public hospital which were admitted due to CAP. The direct cost of treatment was determined by using cost of illness analysis tool.All direct expense during hospitalization i.e those \ud identified with the utilization of medical services assets such as diagnosis, treatment and length of stay were determined in patients hospitalized due to CAP in three private hospitals. Cost was calculated from hospital perspective.</br> \ud All the data were summarized as the code number of all filled questionnaire and further data was first entered in the excel sheets and then studied further in SPSS. In the second part of the study a descriptive analysis approach was utilized to investigate the clinical administration, clinical results and medical services resources. All calculations and data were analyzed utilizing SPSS 15 version. After analysis, we found that the majority (31%) of the physicians recommended clarithromycin as a monotherapy of antibiotic in adults and (21.2%) of the respondents recommends a combination of co- amoxiclave plus clarithromycin. The majority (25.4%) of the respondent recommended clarithromycin asmonotherapy antibiotic in children for the management of CAP patients in an outpatient setting and (21.4%) of doctors recommend ampicillin plus clarithromycin as combination treatment in children for the management of CAP. Where as in three private hospitals. The finding were as follows the mostly prescribed monotherapy antibiotic in adults for the treatment of CAP collective at three private hospitals was Ceftrixone(31.45%) and mostly prescribed combination antibiotic treatment in adults for the management of CAP was ceftrixone plus crithromyin(20.93%).Mostly prescribed antibiotic as monotherapy in children was ceftrixone (75%) and mostly prescribed combination antibiotic therapy in children was cefotaxime plus amikacin(30%).Whereas at the Government hospital the mostly prescribed antibiotic used in adults for the management of CAP was ceftrixone (46.16%). The mostly prescribed combination antibiotic in adults was ceftrixone plus amikacin (20.71%). The mostly prescribed monotherapy of antibiotics at a Government hospital in children was ceftrixone (28.3%) and the mostly prescribed combination therapy in children is ceftrixone plus Cloxacillin (26.31%). Cost of treatment in three private hospitals was determined.The conversion rate of the Pakistani currency to US dollar in 2012 was 1PKR equals to 0.0105USD. Per patients, the median cost of treatment of CAP was (PKRs 9889) and in USD was (103.83USD), consisting of median medication cost (PK Rs.2493) and in USD was (26.176USD) , median diagnostic tests cost (PK Rs.1310) and in USD was (13.75USD)and length of stay median cost were found as PK Rs.5700 and in USD was 59.85USD.Cost based on age, sex and Co morbidity in three private hospitals were determined. The patient has age greater than 70years posses higher cost of treatment than patients having age less than 70years. There was a higher median cost of female patient than the male patient of CAP. The cost of treatment in a patient with a PSI(Pneumonia severity index) class I was (PKRs. 8007), with PSI class II (PKRs 14853), with class III was (PKRs.14930), with PSI class IV (PKRs.46096) and with PSI class V was (PKRs.59851).However, patients have higher age and Co morbidity experience higher expense and higher length of hospital stay. The expense is increasing as the severity of the diseases increases.Guideline \ud -concordant therapy have been proven to be connected with enhanced health and monetary results in the management of CAP. Then again, real utilization of CAP guidelines stays poor, however, actual use of CAP guidelines remains poor, but using tailored interventions looks encouraging. Strategies intend to guarantee right medicine use and early management of Co morbidity may help decrease inpatient expenses in hospitalized patient of CAP