Introduction

Americans spent over $553 billion for health care in 1997.1

Over $200 billion was spent for hospitalizations, $180

billion for ambulatory care, and $72 billion for prescription

medicine.1 Since 1991, prescription drug costs have soared,

increasing faster than the inflation rate.2 The issue of

prescription drug costs has captured the attention of

legislators and policymakers, insurers, health care

providers, and consumers asking the question: Which

medicines work best at the lowest cost? 

The Agency for Healthcare Research and Quality (AHRQ)

has funded research that helps to answer questions about

prescription medicine. AHRQ research has:

• Identified conditions for which drug therapy is not

necessary.

• Discovered low-cost drug therapies that provide patients

with the same quality of care as more expensive drugs.

• Revealed that sometimes the newest, most expensive

drug therapy reduces costs overall because it keeps

patients healthier and less likely to use other health care

services. 

• Investigated the cost effectiveness and safety of

outpatient vs. inpatient services and the impact of

preventive drug therapy.

Background

Prescription drug spending doubled from $60.8 billion in

1995 to $121.8 billion in 2000 and is expected to reach

$160.9 billion in 2002.3 These increases can be attributed to

the research and development of new drugs, as well as the

availability of new, more expensive drugs that either replace

older drugs or provide treatment for a condition that

previously was not treatable.3,4 Consumers are also

purchasing more prescription drugs.3 In 1993, 7

prescriptions were dispensed per person; by 2000, this

number had increased to 10 prescriptions per person.3

AHRQ research projects have been funded to determine

where the costs for treatment can be reduced without

Prescription Drug Therapies: Reducing Costs 

and Improving Outcomes

Making a Difference

• Expensive antibiotic therapy is not always

needed...Page 2

• New expensive drugs can reduce overall costs...

Page 4

• Outpatient pharmaceutical treatment can be as effective

as inpatient treatment and cost less...Page 4

• Preventive drug therapies can be cost effective...

Page 7

RESEARCH IN ACTION

Agency for Healthcare Research and Quality • www.ahrq.gov

Issue #8 September 2002

Authors: Barbara L. Kass-Bartelmes, M.P.H., C.H.E.S., Lynn Bosco, M.D., M.P.H.

Managing Editor: Margaret K. Rutherford

Design and Production: Joel Boches

Suggested citation: Kass-Bartelmes BL, Bosco L, Rutherford MK. Prescription drug therapies: reducing costs and improving outcomes. Rockville (MD): Agency for

Healthcare Research and Quality; 2002. Research in Action Issue 8. AHRQ Pub. No. 02-0045.
reducing the quality of care. The objective is to determine

when older, less expensive drugs or no drug treatment can

work just as well as newer, more expensive drugs.5-10

AHRQ has also funded research to determine whether

limiting the use of certain drugs, such as antibiotics, can

help to reduce the risk of developing antibiotic-resistant

bacteria,11,12 thus decreasing costs related to hospitalization.

Although newer drugs are usually more expensive than

older drugs, they are sometimes more effective than their

older counterparts in reducing illness, hospitalization, or

death,13 and the improvements in health care outcomes can

justify the increased costs.14 Unfortunately, little

information is available to doctors to determine which

therapy works best,5 and very few studies have measured

the cost benefits of new drugs.13

When better health outcomes involve increased costs, the

burden of paying for treatment can have negative

consequences. For example, because of cost issues, some

patients may resort to drug mismanagement (not filling

their prescriptions, taking less than the recommended dose,

saving medications for future use, or taking a medicine

belonging to another person).15,16 Increased prescription

drug costs translate into higher costs for both insurers and

patients and, ultimately, higher health insurance premiums

for all consumers. Reimbursement strategies designed to

save money may be detrimental to patients and may

actually result in higher overall health care costs.17 For

example, limiting reimbursements for drugs can reduce

pharmaceutical costs but increase other costs, such as those

for hospitalization.17

Impact of AHRQ Research

Expensive antibiotics do not always have better

outcomes 

AHRQ research has found that antibiotics are not always

necessary or effective and that less expensive antibiotics

often work just as well as more expensive antibiotics. The

cost of antibiotics varies widely.8,9 For example, antibiotics

to treat middle ear inflammation in children or sinus

infections and community-acquired pneumonia in adults

cost anywhere from $2.00 to $113.00,6,8,10 resulting in

expenses that exceed $4 billion annually.7,9 AHRQ research

shows that several strategies work to reduce antibiotic

expenses.

An AHRQ-funded study that evaluated randomized clinical

trials conducted from 1968 through 1994 found that about

80 percent of children recover from middle ear

inflammation without the use of antibiotics.12 More

appropriate use of antibiotics would not only lower costs,

but reduce the growing problem of antibiotic resistance.

A clinical trial funded by AHRQ showed that amoxicillin

performed no differently than a placebo in preventing

middle ear inflammation in children. The proportion of

children who remained free of inflammation after receiving

amoxicillin twice a day (61 percent) was no different from

the proportion for children who received amoxicillin once a

day and a placebo once a day (64 percent) or children who

received a placebo twice a day (63 percent).7

Researchers funded by AHRQ also found that more

expensive antibiotics were not associated with better

outcomes than less expensive antibiotics for treating middle

ear inflammation in children ages 30 months to 13 years

(Table 1). This retrospective study of children enrolled in

Colorado’s Medicaid program showed that the average rate

at which a second dose was prescribed because the

infection did not respond to the first dose of antibiotics was

11.6 percent for less expensive antibiotics and 13.2 percent

for more expensive antibiotics.8

AHRQ-funded researchers more recently found that older

antibiotics such as amoxicillin provide better treatment

outcomes than newer antibiotics for children with middle

ear inflammation. Researchers for the Center for Education

and Research on Therapeutics (CERTs) at the University of

North Carolina discovered that children covered by

Medicaid in North Carolina who received older drugs had

fewer return visits to their physicians than children who

received newer, more expensive drugs. The average cost of

drug therapy for older drugs such as amoxicillin was

$12.00, while the newer drugs cost an average of $42.00.18

AHRQ funded an evaluation of randomized trials that

showed 69 percent of patients with an uncomplicated sinus

infection recovered without any antibiotic treatment at all.

Researchers reviewed randomized clinical trials conducted

from 1970 through 1998 that compared the use of older

antibiotics (amoxicillin and folate inhibitors) with placebos

and antibiotics that were newer and more expensive at the

time of the studies (such as azithromycin, clarithromycin,

and cefixime). Their analysis showed that two-thirds of the

patients using placebos got well without any treatment, and

2 www.ahrq.gov
the older antibiotics worked just as well as the newer

antibiotics.5

The AHRQ Patient Outcomes Research Team (PORT) on

pneumonia found that there were no differences in

outcomes between outpatients with community-acquired

pneumonia who were treated with less expensive antibiotics

and those treated with more expensive antibiotics.9 In an

observational study, patients who received treatment with

antibiotics whose average daily costs were relatively

inexpensive (ranging from 36¢ to $4.04) had outcomes

similar to those of patients who were given more expensive

antibiotics (ranging from $5.10 to $7.52 per day).9,10

A second observational study conducted by the AHRQ

pneumonia PORT examined antibiotic costs and outcomes

among outpatients with community-acquired pneumonia at

five different medical institutions. The treatment site with

the lowest antibiotic cost also had the lowest rates of

subsequent hospital admissions, while the facility with the

highest costs had the highest rate (Table 2).10

Finally, a clinical trial funded by AHRQ at Brigham and

Women’s Hospital, in Boston, found that costs could be

reduced by decreasing prescription orders for the antibiotic

vancomycin. Vancomycin was at one time the only

antibiotic physicians could use to treat bacteria that had

become resistant to all other antibiotics. It is prescribed

primarily for patients who have a serious infection that is

resistant to other antibiotics, who are allergic to other

antibiotics, or who may have sepsis, and to prevent

infection in patients who are about to undergo surgery.

Overuse of vancomycin in the past 10 years, however, has

resulted in the emergence of at least one strain of bacteria

that is showing vancomycin resistance. Controlling the use

of vancomycin would help to control development of new

strains of antibiotic-resistant bacteria.11

All of the physicians studied used computerized order

entry. The intervention group received computerized

guidelines for ordering intravenous vancomycin; the control

group of physicians did not. When compared to the control

group of physicians, intervention physicians:

• Ordered 29 percent less initial courses of vancomycin.

• Wrote 36 percent less renewal orders.

• Had 32 percent less total orders for vancomycin.

• Prescribed vancomycin for 28 percent less patients.

• Prescribed vancomycin for 36 percent less days.11

The number of patients who received vancomycin during

their hospitalization decreased by 15 percent (from 2,715 to

www.ahrq.gov 3

Table 1. Percent of children ages 30 months to 13 years with unresponsive acute otitis media by type and cost

of oral antibiotics

Percent of children prescribed a second 

course of antibiotics

Cost range

Antibiotic (10-day course) Within 10 days Within 24 days

Amoxicillin $2.94-$5.88 2.8 11.6

Amoxicillin/clavulanate $48.70-$97.44 3.1 13.3

Cefaclor $41.83-$86.16 2.2 10.7

Cefixime $44.33-$86.16 2.1 12.9

Erythromycin with sulfa $24.99-$48.36 3.3 12.3

Trimethoprim with sulfa $1.35-$6.92 1.8 13.4

Source: Berman S, Byrns PJ, Bondy J, et al. Otitis media-related antibiotic prescribing patterns, outcomes, and expenditures in a pediatric Medicaid population. Pediatrics 1997;

100(4):585-92.
2,341) compared to 9 months prior to the study. This might

have led to a cost savings of $90,000 per year. However,

because many patients still required treatment for infection

or to prevent infection, another antibiotic would have been

prescribed instead of vancomycin. For example, physicians

may have substituted cefazolin, which cost $9.00 per day

compared to $12.00 per day for vancomycin. The hospital

still saved $22,500 a year. Because of the impact the

computerized guidelines had on physician ordering

practices, at the study’s conclusion these guidelines were

made available to all users of the computerized order entry

system.11

New expensive drugs can reduce overall costs

In some instances newer, more expensive drugs can lead to

cost benefits. For example, new drugs could provide

treatment for conditions such as HIV for which very few

treatments had previously existed. In addition, newer drugs

may be more effective, have fewer side effects, and

represent better quality of care than older drugs. They also

may lower costs overall by lessening the need for other

health care services.4

An AHRQ-funded observational study done soon after the

approval of the first protease inhibitors (drugs that keep

HIV from reproducing) in the mid and late 1990s showed

that HIV-infected patients taking protease inhibitors had

lower hospital inpatient costs, community care costs, and

costs associated with the treatment of opportunistic illness.

Researchers found that the average monthly Medicaid

payments for pharmacy costs were higher for patients

taking protease inhibitors. However, Medicaid patients

who took protease inhibitors, when compared to Medicaid

patients who did not, had:

• Significantly lower average monthly total payments for

the sickest patients (those with low CD4a cell counts) in

1997 (Table 3).

• Significantly lower payments when hospitalized with an

opportunistic illness both in 1996 and 1997 (Figure 1). 19

Outpatient drug treatment can be effective and

reduce costs

AHRQ research has demonstrated that some drug

treatments offered on an outpatient basis have the same

outcomes as those given on an inpatient basis at lower cost.

For example, treating women with pelvic inflammatory

disease (PID) as outpatients rather than inpatients could

save as much as $500 million a year.20

PID, an infection and inflammation of organs in the pelvis,

affects about 1.2 million women in the United States each

year, resulting in infertility, chronic pelvic pain, and ectopic

pregnancies. AHRQ funded the PID Evaluation and

Clinical Health (PEACH) Study, which conducted a clinical

trial to compare the effectiveness of inpatient and outpatient

treatment. After 30 days, there were no significant

differences in adverse outcomes between the outpatient and

4 www.ahrq.gov

Table 2. Costs and subsequent admission rates for outpatients with community-acquired pneumonia at five

medical institutions

Study sitea

Item UPMC SFMC MGH HCHP VGH

Median cost $6.10 $54.90 $7.70 $5.40 $7.50

Subsequent hospital admission 13.0% 22.2% 7.9% 2.2% 4.7%

a

UPMC—University of Pittsburgh Medical Center; SFMC—St. Francis Medical Center; MGH— Massachusetts General Hospital; HCHP—Harvard Community Health Plan, Kenmore

Center; VGH—Victoria General Hospital.

Source: Gilbert K, Gleason PP, Singer DE, et al. Variations in antimicrobial use and cost in more than 2,000 patients with community-acquired pneumonia. Am J Med 1998; 

104:17-27.

a

CD4 cells are a type of white blood cell that helps the body fight off

infections. HIV invades CD4 cells. Eventually, the body loses its ability

to produce CD4 cells and therefore loses its ability to fight infection.
www.ahrq.gov 5

Table 3. Average monthly Medicaid payments for HIV patients by protease inhibitor use

1996 1997

No protease Protease No protease Protease

inhibitor inhibitor inhibitor inhibitor

CD4 cell count and cost use use use use

CD4 cell count less than 50 x 106

Pharmacy cost $487 $852 $508 $745

Total average cost $2,047 $1,704 $2,805 $1,814

CD4 cell count 50-200 x 106

Pharmacy cost $390 $663 $398 $763

Total average cost $1,515 $1,123 $1,495 $1,623

CD4 cell count 200-500 x 106

Pharmacy cost $267 $455 $299 $652

Total average cost $1,036 $780 $1,395 $1,031

Note: Total average cost includes inpatient, outpatient, pharmacy, community care, and emergency room costs.

Source: Gebo KA, Chaisson RE, Folkemer JG, et al. Costs of HIV medical care in the era of highly active antiretroviral therapy. AIDS 1999; 13(8):963-9.

No protease inhibitor Protease inhibitor

1995 1996 1997

$0

$100

$200

$300

$400

$500

$600

$700

Average monthly payment

Figure 1. Average inpatient Medicaid payment per month for hospitalization associated with a principal discharge

diagnosis of opportunistic illness for HIV patients

Source: Gebo KA, Chaisson RE, Folkemer JG, et al. Costs of HIV medical care in the era of highly active antiretroviral therapy. AIDS 1999; 13(8):963-9.
6 www.ahrq.gov

Inpatient Outpatient

0.9% 1.7%

20.6%

0.7% 1.5%

3.4%

18.4%

Tubo-ovarian abscess Adverse drug reacton Phlebitis Tenderness

0

5

10

15

20

25

0.0%

Percent

Adverse event

Figure 2. Percent of adverse events after 30 days for women treated for pelvic inflammatory disease by

treatment group

Source: Ness RB, Soper DE, Holley RL, et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory

Disease Evaluation and Clinical Health (PEACH) randomized trial. Am J Obstet Gynecol 2002; 186(5):929-37.

42.0%

18.4%

1.7% 1.0%

41.2%

33.7%

41.7%

17.9%

1.5% 0.3%

33.3%

29.8%

Pregnancy Infertility Hysterectomy Ectopic pregnancy Tubal obstructions Chronic pelvic pain

0

5

10

15

20

25

30

35

40

45 Inpatient Outpatient

Percent

Outcome

Figure 3. Long-term outcomes (average of 35 months) for women treated for pelvic inflammatory disease by

treatment group

Source: Ness RB, Soper DE, Holley RL, et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory

Disease Evaluation and Clinical Health (PEACH) randomized trial. Am J Obstet Gynecol 2002; 186(5):929-37.
www.ahrq.gov 7

inpatient treatment groups, with the exception of phlebitis

(inflammation of a vein) sometimes caused in inpatients by

intravenous treatment with the antibiotic doxycycline

(Figure 2). After an average followup period of 35 months,

there were no differences in outcomes between outpatients

and inpatients (Figure 3).20

Preventive drug therapy can be cost effective

AHRQ research has shown that using drugs to prevent

opportunistic illnesses such as Pneumocystis carinii

pneumonia (PCP) in HIV patients can lower costs. Drugs

such as trimethoprim-sulfamethoxazole (TMP-SMZ),

aerosol pentamidine, or dapsone can help prevent PCP, but

many patients do not receive these medications.21-23

Researchers funded by AHRQ in the early 1990s examined

past charts of HIV patients. They found that, among

patients who developed PCP, those who took preventive

drugs were less likely to require hospitalization or

admission to the intensive care unit than those who did not

take preventive drugs (Table 4). Patients who did not take

preventive drugs accounted for 800 (85 percent) of 937

hospital days associated with this illness and were also

more likely to die.21 More recent studies conducted by

other researchers confirm that preventive drug therapy in

HIV patients reduces the risk of PCP as well as other

bacterial infections.22-24 Public Health Service guidelines

today recommend that persons with CD4 counts less than

200 take drug therapy to prevent PCP, and treatment with

TMP-SMX is covered under all of the Drug Assistance

Programs funded by the Ryan White CARE Act.25

Ongoing Research

AHRQ continues to fund studies that investigate the costs

and outcomes of pharmaceutical therapies.

Consequences of Drug Cost Sharing in the Elderly;

Brigham and Women’s Hospital, Boston, MA, Grant No.

R01 HS10881-01. This study is examining the effects of

differential cost sharing for pharmaceutical costs, an

increasingly common strategy to discourage use of more

expensive medications in many drug benefits plans.

Specifically, researchers will assess the impact of

differential cost sharing applied to angiotensin-converting

enzyme inhibitors and calcium channel blockers on patterns

of medication use and health care use in all elderly

recipients of these drugs. 

Effect of Medicaid Drug Copayments on Outcomes and

Costs; University of Minnesota, Grant No. R03 HS10791-

01. This study is estimating the effect of Medicaid

prescription drug copayments on the use of drugs and other

types of health care and on total Medicaid expenditures. 

Patient-Centered Care and Health Care Costs;

University of Rochester, Grant No. R01 HS10610-01A1.

This research study is examining the relationship between

measures of physicians’ patient-centeredness (a process

where the physician incorporates the patient’s experience of

illness and shares decisionmaking) and patients’ health care

costs (total, inpatient, outpatient, testing, and medication),

health status, and satisfaction. It will also characterize

features of patient-physician communication that contribute

to lower health care costs.

Centers for Education and Research on Therapeutics

(CERTs). The CERTs demonstration program is a national

initiative to conduct research and provide education that

advances the optimal use of therapeutics (drugs, medical

devices, and biological products). The program is

administered as a cooperative agreement by AHRQ in

consultation with the U.S. Food and Drug Administration.

The research conducted by the CERTs program is intended

to increase awareness of the uses and risks of new drugs

Table 4. Hospitalization, mortality, and resource

use over a 1-year period for HIV patients who

developed PCP

Taking preventive drugs

Item Yes No

Number of patients:

Hospitalized 11 54

Had an ICU stay 0 10

Died 0 12

Total hospital days 137 800

ICU days 0 202

Total charges $95,932 $753,608

Note: ICU—intensive care unit. PCP—Pneumocystis carinii pneumonia.

Source: Gallant JE, McAvinue SM, Moore RD, et al. The impact of prophylaxis on

outcome and resource utilization in Pneumocystis carinii pneumonia. Chest 1995;

107:1018-23.
and drug combinations, biological products, and devices as

well as ways to improve their safe and effective use. The

CERTs research will improve quality while reducing the

cost of care by increasing the appropriate use of drugs,

biological products, and devices and by preventing their

adverse effects and consequences. The CERTs centers are:

• Duke University (HS10548): Therapies for disorders of

the heart and blood vessels. 

• HMO Research Network (HS10391): Usefulness of

health maintenance organizations for studying drug use,

safety, and effectiveness. 

• University of Alabama-Birmingham (HS10389):

Therapies for disorders of the joints and bones. 

• University of Arizona (HS10385): Reduction of adverse

drug interactions, especially in women. 

• University of North Carolina (HS10397): Therapies for

children. 

• University of Pennsylvania (HS10399): Therapies for

infection and antibiotic drug resistance. 

• Vanderbilt University (HS10384): Prescription drug use

in a Medicaid population.26

Conclusion

AHRQ-funded research helps identify drug therapies that

can lower health care costs while maintaining quality of

care. Less expensive drugs such as antibiotics can work

just as effectively as more expensive drugs, lowering costs

without compromising patients’ health. However, some

newer, more expensive drugs can also lower costs because

they improve patients’ health overall and reduce other

medical expenses. More research needs to be conducted to

identify those new drugs that have an advantage over older,

existing drugs. AHRQ research has shown that some drug

therapies can be provided on an outpatient basis, thus

saving the costs of inpatient treatment. Finally, studies

funded by AHRQ have helped lower costs by showing the

benefit of providing preventive drug therapies. 

For more information

For more information about AHRQ research on

pharmaceuticals, please contact Lynn Bosco, M.D., M.P.H.,

at 301-594-2416 or lbosco@ahrq.gov.

References

*1. Agency for Healthcare Research and Quality, Center for

Cost and Financing Studies. Health care expenses in the

U.S. civilian noninstitutionalized population, 1997.

Rockville (MD), 2001. AHRQ Pub. No. 01-R086.

AHRQ Web site: <http://www.meps.ahrq.gov/

papers/rf_01-r035/statisticaltables.htm>. Accessed

August 28, 2002. 

2. Kaiser Family Foundation, Williams C, Treloar J. Trends

and indicators in the changing health care marketplace;

2002. Kaiser Family Foundation Web site:

<http://www.kff.org/content/2002/3161/>. Accessed

September 10, 2002. 

3. Gluck ME. Federal policies affecting the cost and

availability of new pharmaceuticals. July 2002. 

Kaiser Family Foundation Web site:

<http://www.kff.org/content/2002/3254/>. Accessed

September 10, 2002. 

4. Merlis M. Explaining the growth in prescription drug

spending: a review of recent studies. Background paper

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2002.

*5. De Ferranti SD, Ioannidis JP, Lau J, et al. Are

amoxycillin and folate inhibitors as effective as other

antibiotics for acute sinusitis? A meta-analysis. BMJ

1998; 317(7159):632-7.

*6. Balk EM, Zucker DR, Engels EA, et al. Strategies for

diagnosing and treating suspected acute bacterial

sinusitis: a cost-effectiveness analysis. J Gen Intern Med

2001; 16(10):701-11.

*7. Roark R, Berman S. Continuous twice daily or once

daily amoxicillin prophylaxis compared with placebo for

children with recurrent acute otitis media. Pediatr Infect

Dis J 1997; 16(4):376-81.

* AHRQ-funded/sponsored research

8 www.ahrq.gov
*8. Berman S, Byrns PJ, Bondy J, et al. Otitis media-related

antibiotic prescribing patterns, outcomes, and

expenditures in a pediatric Medicaid population.

Pediatrics 1997; 100(4):585-92.

*9. Gleason PP, Kapoor WN, Stone RA, et al. Medical

outcomes and antimicrobial costs with the use of the

American Thoracic Society Guidelines for outpatients

with community-acquired pneumonia. JAMA 1997;

278(1):32-9.

*10. Gilbert K, Gleason PP, Singer DE, et al. Variations in

antimicrobial use and cost in more than 2,000 patients

with community-acquired pneumonia. Am J Med 1998,

104:17-27.

*11. Shojania KG, Yokoe D, Platt R, et al. Reducing

vancomycin use utilizing a computer guideline: results

of a randomized controlled trial. J Am Med Inform

Assoc 1998; 5(6):554-62.

*12. Froom J, Culpepper L, Jacobs M, et al. Antimicrobials

for acute otitis media? A review from the international

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13. Lichtenberg FR. Are the benefits of newer drugs worth

their cost? Evidence from the 1996 MEPS. Health Aff

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*14. Agency for Healthcare Research and Quality. Focus on

cost-effectiveness analysis at the Agency for Healthcare

Research and Quality. Rockville (MD), 2001. AHRQ

Pub. No. 01-P023. AHRQ Web site:

<http://www.ahrq.gov/research/costeff.pdf>. Accessed

September 12, 2002.

15. Mitchell J, Mathews HF, Hunt LM, et al. Mismanaging

prescription medications among rural elders: the effects

of socioeconomic status, health status, and medication

profile indicators. Gerontologist 2001; 41(3):348-56.

16. Kennedy J, Erb C. Prescription noncompliance due to

cost among adults with disabilities in the United States.

Am J Public Health 2002; 92(7):1120-4.

*17. Soumerai SB, McLaughlin TJ, Ross-Degnan D, et al.

Effects of limiting Medicaid drug-reimbursement

benefits on the use of psychotropic agents and acute

mental health services by patients with schizophrenia. N

Engl J Med 1994; 331:650-5.

*18. Ringel-Kulka T, Tolleson-Rinehart S, Christensen DB.

Antibiotic choice and treatment outcomes for acute otitis

media. August 2002. Centers for Education and Research

on Therapeutics Web site: <http://certs.hhs.gov/

newsarchive/2002/20020808_01.html>. Accessed

September 17, 2002.

*19. Gebo KA, Chaisson RE, Folkemer JG, et al. Costs of

HIV medical care in the era of highly active

antiretroviral therapy. AIDS 1999; 13(8):963-9.

*20. Ness RB, Soper DE, Holley RL, et al. Effectiveness of

inpatient and outpatient treatment strategies for women

with pelvic inflammatory disease: results from the

Pelvic Inflammatory Disease Evaluation and Clinical

Health (PEACH) randomized trial. Am J Obstet Gynecol

2002; 186(5):929-37.

*21. Gallant JE, McAvinue SM, Moore RD, et al. The impact

of prophylaxis on outcome and resource utilization in

Pneumocystis carinii pneumonia. Chest 1995; 107:1018-

23.

22. DiRienzo AG, van Der Horst C, Finkelstein DM, et al.

Efficacy of trimethoprim-sulfamethoxazole for the

prevention of bacterial infections in a randomized

prophylaxis trial of patients with advanced HIV

infection. AIDS Res Hum Retroviruses 2002; 18(2):

89-94.

23. Dworkin MS, Williamson J, Jones JL, et al. Prophylaxis

with trimethoprim-sulfamethoxazole for human

immunodeficiency virus-infected patients: impact on

risk for infectious diseases. Clin Infect Dis 2001;

33(3):393-8.

24. Effect of trimethoprim-sulfamethoxazole as

Pneumocystis carinii pneumonia prophylaxis on

bacterial illness, Pneumocystis carinii pneumonia, and

death in persons with AIDS. J Acquir Immune Defic

Syndr Hum Retrovirol 1999; 20(2):201-6

25. Hellinger F, Agency for Healthcare Research and

Quality. Pharmaceutical costs synthesis. Personal e-mail

to Barbara Kass-Bartelmes. September 16, 2002.

*26. Agency for Healthcare Research and Quality. Centers

for Education and Research on Therapeutics. Rockville,

MD, 2002. AHRQ Pub. No. 02-P025. AHRQ Web site:

<http://www.ahrq.gov/clinic/certsovr.htm>. Accessed

September 12, 2002.

* AHRQ-funded/sponsored research

www.ahrq.gov 9
www.ahrq.gov 11

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7 Improving Treatment Decisions for Patients with Community- AHRQ 02-0033

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6 Medical Informatics for Better and Safer Health Care AHRQ 02-0031

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