Discharged Patients Who Skip Antibiotic Likely to Be Rehospitalized

A new study has found that patients who skip an antibiotic often used by hospitals to combat infection during patients’ stays and prescribed to continue that fight after discharge are more likely to return to the hospital. The antibiotic, linezolid, is available in both oral and intravenous forms, and has received high marks for its ability to treat difficult infections, including ventilator-acquired pneumonia and skin and soft-tissue infections. The drug is given intravenously while the patients are hospitalized and then in pill form after discharge.

Published in The American Journal of Managed Care, the study was led by Margaret K. Pasquale, PhD, of Comprehensive Insights, a subsidiary of Humana Inc., which jointly funded the study with Pfizer Inc., marketer of linezolid. In the study, researchers used Humana’s database to identify Medicare patients prescribed oral linezolid between June 1, 2007, and April 30, 2011. A total of 1,062 Medicare patients were identified, 16.5 percent who reversed a prescription for the drug. Among those reversing prescriptions, 73 percent received a different antibiotic and 27 percent received no antibiotic. But, the savings for this group overall was short-lived; infection-related hospitalizations were 14 percent higher for this group than for those who took linezolid as prescribed (23 percent vs. 9 percent), and the mean post-discharge cost was $1,280.93 higher than those who took the drug as directed.

Researchers speculated that high costs drive the decision to not fill prescriptions, as evidenced by the fact that the poorest patients were more likely to fill their orders for oral linezolid, since they had the lowest out-of-pocket costs. Oral linezolid is an expensive medication, and researchers found varying co-payment and coinsurance levels among the study population. The mean out-of-pocket cost for recipients with a co-payment was $7.05, while the mean out-of-pocket cost for those who paid a percent of co-insurance was $466.52. Of those patients whose out-of-pocket costs exceeded $100, 27 percent did not fill the prescription. “If economic factors did indeed influence the decision to fill or reverse the linezolid prescription, then strategies to reduce member out-of-pocket costs (e.g., benefit design) for all health plan members could enable better member access and, in turn, reduce total healthcare costs,” the researchers wrote.