The European Journal of Health Economics

, Volume 12, Issue 4, pp 319–329 | Cite as

Resource use and costs of treating acute cough/lower respiratory tract infections in 13 European countries: results and challenges

  • Raymond Oppong
  • Joanna Coast
  • Kerry Hood
  • Jacqui Nuttall
  • Richard D. Smith
  • Christopher C. Butler
Original Paper


The objectives of this study were to estimate the resource use and cost of treating acute cough/lower respiratory tract infection (acute cough/LRTI) in 13 European countries, to explore reasons for differences in cost and to document the challenges that researchers face when collecting information on cost alongside multinational studies. Data on resource use and cost were collected alongside an observational study in 14 primary care networks across 13 European countries and a mean cost was generated for each network. The results show that the mean cost (standard deviation) of treating acute cough/LRTI in Europe ranged from €23.88 (34.67) in Balatonfüred (Hungary) to €116.47 (34.29) in Jonkoping (Sweden). The observed differences in costs were statistically significant (P < 0.01). Major cost drivers include general practitioner visits and drug costs in all networks, whilst differences in health systems and regional factors could account for differences in cost between networks. The major barrier to conducting multinational cost studies are barriers associated with identifying cost information.


Infection Antibiotics Resource use Cost Cough 

JEL classification



  1. 1.
    Ball, P., et al.: Antibiotic therapy of community acquired lower respiratory tract infections: strategies for optimal outcomes and minimized resistance emergence. J. Antimicrob. Chemother. 49, 31–40 (2002)PubMedCrossRefGoogle Scholar
  2. 2.
    Ortqvist, A.: Treatment of community acquired lower respiratory tract infections in adults. Eur. Respir. J. 20(Suppl 36), 40S–53S (2002)CrossRefGoogle Scholar
  3. 3.
    Ehlke, B., et al.: Economic impact of community-acquired and nosocomial lower respiratory tract infections in young children in Germany. Eur. J. Pediatr. 164(10), 607–615 (2005)CrossRefGoogle Scholar
  4. 4.
    Guest, J.F., Morris, A.: Community-acquired pneumonia: the annual cost to the National Health Service in the UK. Eur. Respir. J. 10, 1530–1534 (1997)Google Scholar
  5. 5.
    Guthrie, R.: Community acquired lower respiratory tract infections: etiology and treatment. Chest 120, 2021–2034 (2001)PubMedCrossRefGoogle Scholar
  6. 6.
    SIGN.: Community management of lower respiratory tract infection in adults. SIGN Publication No. 59. ISBN 1899893 08 3. Published June 2002 (2002),
  7. 7.
    Hak, E., et al.: Prognostic factors for serious morbidity and mortality from community-acquired lower respiratory tract infections among the elderly in primary care. Fam. Pract. 22, 375–380 (2005)PubMedCrossRefGoogle Scholar
  8. 8.
    Cals, J.W.L., et al.: Improving management of patients with acute cough by C-reactive protein point of care testing and community training (IMPACT): study protocol of a cluster randomised controlled trial. BMC Fam. Pract. 8, 15 (2007)PubMedCrossRefGoogle Scholar
  9. 9.
    Gjelstad, S., et al.: Can antibiotic prescriptions in respiratory tract infections be improved? A cluster-randomized educational intervention in general practice—the prescribing peer academic detailing study. BMC Health Serv. Res. 6, 75 (2006)PubMedCrossRefGoogle Scholar
  10. 10.
    Goosens, H., et al.: National campaigns to improve antibiotic use. Eur. J. Clin. Pharmacol. 62, 373–379 (2006)CrossRefGoogle Scholar
  11. 11.
    Coenen, S., et al.: Optimizing antibiotic prescribing for acute cough in general practice: a cluster-randomized controlled trial. J. Antimicrob. Chemother. 54, 661–672 (2004)PubMedCrossRefGoogle Scholar
  12. 12.
    Van Driel, M.L., et al.: What is the role of quality circles in strategies to optimise antibiotic prescribing? A pragmatic cluster-randomised controlled trial in primary care. Qual. Saf. Health Care 16, 197–202 (2007)PubMedCrossRefGoogle Scholar
  13. 13.
    Kristinsson, K.G.: Effects of antimicrobial use and other risk factors on antimicrobial resistance in pneumococci. Microb. Drug Resist. 3, 117–123 (1997)PubMedCrossRefGoogle Scholar
  14. 14.
    Christ-Crain, M., Jaccard-Stolz, D., Bingisser, R., Gencay, M.M., Huber, P.R., Tamm, M., Muller, B.: Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections. Cluster randomised, single blinded intervention trial. Lancet 363, 600–607 (2004)PubMedCrossRefGoogle Scholar
  15. 15.
    Manca, A., et al.: Assessing the generalizability by location in trial based cost-effectiveness analysis: the use of multilevel models. Health Econ. 14, 471–485 (2005)PubMedCrossRefGoogle Scholar
  16. 16.
    Pang, F.: Design, analysis and presentation of multinational economic studies: the need for guidance. Pharmacoeconomics 20(2), 75–90 (2002)PubMedCrossRefGoogle Scholar
  17. 17.
    Raikou, M., et al.: Centre specific or average unit costs in multinational clinical trials? Some theory and simulation. Health Econ. 9, 191–198 (2000)PubMedCrossRefGoogle Scholar
  18. 18.
    Virk, K.P.: Global clinical trials: the challenge of language. Drug Inform. Assoc. 44(4), 21–23 (2008)Google Scholar
  19. 19.
    Schulman, K., et al.: Resource costing for multinational neurologic clinical trials: methods and results. Health Econ. 7, 629–638 (1998)PubMedCrossRefGoogle Scholar
  20. 20.
    Wordsworth, S., et al.: Collecting unit costs data in multicentre studies creating comparable methods European. J. Health Econ. 50, 38–44 (2005)Google Scholar
  21. 21.
    Koopmanscap, M.A., et al.: Analysis of cost and cost-effectiveness in multinational trials. Health Policy 58, 175–186 (2001)CrossRefGoogle Scholar
  22. 22.
    Butler, C.C., et al.: Variation in antibiotic prescribing and its impact on recovery in patients with acute cough in primary care: prospective study in 13 countries. BMJ 338, b2242 (2009)PubMedCrossRefGoogle Scholar
  23. 23.
    Banque de France.
  24. 24.
    OECD Purchasing Power Parities (PPPs) for OECD Countries Since 1980.
  25. 25.
    Donner, A., Klar, N.: Design and analysis of cluster randomization trials in health research. Hodder Arnold, London (2000)Google Scholar
  26. 26.
    Rurik, I.: Primary care diabetes in Hungary. Prim. Care Diabetes 177–179 (2007)Google Scholar
  27. 27.
    Little, P.: Delayed prescribing of antibiotics for upper respiratory tract infection. BMJ 331, 301–302 (2005)PubMedCrossRefGoogle Scholar
  28. 28.
    NICE.: Respiratory tract infections—antibiotic prescribing. Prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care. (2008)
  29. 29.
    De Smet, P.: Herbal medicine in Europe—relaxing regulatory standards. N. Engl. J. Med. 352, 1176–1178 (2005)PubMedCrossRefGoogle Scholar
  30. 30.
    Goosens, H., et al.: Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 365, 579–587 (2005)Google Scholar
  31. 31.
    Grytten, J., Sorensen, R.: Type of contract and supplier—induced demand for primary physicians in Norway. J. Health Econ. 20, 379–393 (2001)PubMedCrossRefGoogle Scholar
  32. 32.
    Birnbaum, H.G., et al.: Lower respiratory tract infections impact on the workplace. Pharmacoeconomics 21(10), 749–759 (2003)PubMedCrossRefGoogle Scholar
  33. 33.
    Cook, J.R., et al.: Assessing the appropriateness of combining economic data from multinational clinical trials. Stat. Med. 22, 1955–1976 (2003)PubMedCrossRefGoogle Scholar
  34. 34.
    Reed, S.D., et al.: Conducting economic evaluations alongside multinational clinical trials: towards a research consensus. Am. Heart J. 149(3), 434–443 (2005)PubMedCrossRefGoogle Scholar
  35. 35.
    Epstein, D., et al.: The hospital care for stroke in nine European countries. Health Econ. 17, S21–S31 (2008)PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Raymond Oppong
    • 1
  • Joanna Coast
    • 1
  • Kerry Hood
    • 2
  • Jacqui Nuttall
    • 2
  • Richard D. Smith
    • 3
  • Christopher C. Butler
    • 2
  1. 1.Health Economics Unit, School of Health and Population SciencesUniversity of BirminghamBirminghamUK
  2. 2.Department of Primary Care and Public HealthCardiff UniversityCardiffUK
  3. 3.Health Policy Unit, Department of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUSA

Personalised recommendations