Chronic Obstructive Pulmonary Disease
Conditions
Keywords
AECOPD, Chronic Obstructive Pulmonary Disease, Acute exacerbation, Hospitalization, Azithromycin, Macrolides, Randomized Controlled Trial, Placebo, Economic Impact, Cost-effectiveness, EQ5D
Brief summary
A second sub-analysis of the BACE trial will include a detailed cost-effectiveness study.
Detailed description
Our multicenter randomized trial executed in one country will provide an excellent tool for more precise health economic assessments. In a first approach, rough estimates on savings of direct costs in the entire study cohort will be made by taking into account the Flemish average costs for a single hospitalization day at a respiratory ward, for a day at intensive care, for an emergency visit, for a home physician contact and for an antibiotic-steroid course. A more detailed cost-effectiveness and cost-utility analysis at 3 and 9 months interval will only be performed in case significant clinical benefits are found in favor of the active treatment. For this purpose medical resource use data will be collected retrospectively via hospital invoices (direct costs including drugs, physician visits, laboratory tests, technical exams, medical imaging, hospital stay) but also prospectively via patient diaries, to cover direct and indirect costs during the entire outpatient period, and will be linked to EQ5D scores. Patient will have to give informed consent that additional to the clinical evaluation, invoices will be collected. However, individual patients can still opt out for these analyses (sub-study) and only participate in the medical intervention study (main study).
Interventions
DRUGAzithromycin
From day 1 up to and including day 3: 500 mg azithromycin or placebo PO once a day From day 4 up to and including day 90: 250 mg azithromycin or placebo PO once every 2 days
DRUGPlacebo
Sponsors
Wim Janssens
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Established diagnosis of COPD by medical doctor (based on clinical history OR pulmonary function test) * Smoking history of at least 10 pack-years (10 pack-years are defined as 20 cigarettes a day for 10 years, or 10 cigarettes a day for 20 years, etc.) * Current hospitalization for potential infectious AECOPD treated with standard therapy * History of at least one exacerbation during the last year (prior to the current hospital admission) for which systemic steroids and/or antibiotics were taken * ECG at admission
Exclusion criteria
* Mechanical or non-invasive ventilation at moment of randomization (D1) * Long QT interval on ECG (QTc \> 450msec for males or \> 470msec for females) * History of life-threatening arrhythmias * Myocardial infarction (NSTEMI or STEMI) less than 6 weeks before start of study drug * Unstable angina pectoris or acute myocardial infarction (NSTEMI or STEMI) at admission * Drugs with high risk for long QT interval and torsade de pointes (amiodarone, flecainide, procainamide, sotalol, droperidol, haldol, citalopram, other macrolides) * Documented uncorrected severe hypokalemia (K+ \< 3.0 mmol/L) or hypomagnesemia (Mg2+ \< 0.5 mmol/L) * Chronic systemic steroids (\> 4 mg methylprednisolone /day for ≥ 2 months) * Actual use of macrolides for at least 2 weeks * Allergy to macrolides * Active cancer treatment * Life expectancy \< 3 months * Pregnant or breast-feeding subjects. Woman of childbearing potential must have a pregnancy test performed and a negative result must be documented before start of treatment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total cost (direct and Indirect cost) during the entire study participation | At 3 month interval | Direct costs (including drugs, physician visits, laboratory tests, technical exams, medical imaging, hospital stay) will be assessed by collecting the medical resource use data retrospectively via hospital invoices and prospectively via patient diaries. Indirect costs (relating to time, convenience, and transportation) will be assessed by collecting the medical resource use data prospectively via patient diaries. This outcome measure will also be analysed in following subgroups: * Male vs female * Smoker vs ex-smoker (stopped smoking \> 6 months) * GOLD A, B vs GOLD C vs GOLD D * Former GOLD I, II vs III vs IV * High CRP (\> 50 mg/dL) vs low CRP (\< 50 mg/dL) * Age \< 60 years vs age 60 - 70 years vs age \> 70 years * Anthonissen I vs Anthonissen II vs Anthonissen III at admission * ICS use vs no ICS use |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total cost (direct and Indirect cost) during the entire study participation | At 9 month interval | Direct costs (including drugs, physician visits, laboratory tests, technical exams, medical imaging, hospital stay) will be assessed by collecting the medical resource use data retrospectively via hospital invoices and prospectively via patient diaries. Indirect costs (relating to time, convenience, and transportation) will be assessed by collecting the medical resource use data prospectively via patient diaries. This outcome measure will also be analysed in following subgroups: * Male vs female * Smoker vs ex-smoker (stopped smoking \> 6 months) * GOLD A, B vs GOLD C vs GOLD D * Former GOLD I, II vs III vs IV * High CRP (\> 50 mg/dL) vs low CRP (\< 50 mg/dL) * Age \< 60 years vs age 60 - 70 years vs age \> 70 years * Anthonissen I vs Anthonissen II vs Anthonissen III at admission * ICS use vs no ICS use |
Countries
Belgium
Outcome results
None listed