Cost-effectiveness of antibiotic treatment strategies for community-acquired pneumonia: results from a cluster randomized cross-over trial. Issue 1 (December 2017)

• Record Type: Journal Article
• Authors: van Werkhoven, Cornelis; Postma, Douwe; Mangen, Marie-Josee; Oosterheert, Jan; Bonten, Marc
• Is Part Of: BMC infectious diseases. Volume 17:Issue 1(2017)
• Page Start: 1
• Page End: 8
• Publication Date: 2017-12
• Subjects: Beta-lactam macrolide -- Fluoroquinolone -- Cost-effectiveness -- Community acquired pneumonia; Communicable diseases -- Periodicals; Sexually Transmitted Diseases -- Periodicals; 616.905
• DOI: 10.1186/s12879-016-2179-6
• Languages: English
• ISSNs: 1471-2334

Abstract

Abstract Background To determine the cost-effectiveness of strategies of preferred antibiotic treatment with beta-lactam/macrolide combination or fluoroquinolone monotherapy compared to beta-lactam monotherapy. Methods Costs and effects were estimated using data from a cluster-randomized cross-over trial of antibiotic treatment strategies, primarily from the reduced third payer perspective (i.e. hospital admission costs). Cost-minimization analysis (CMA) and cost-effectiveness analysis (CEA) were performed using linear mixed models. CMA results were expressed as difference in costs per patient. CEA results were expressed as incremental cost-effectiveness ratios (ICER) showing additional costs per prevented death. Results A total of 2, 283 patients were included. Crude average costs within 90 days from the reduced third payer perspective were €4, 294, €4, 392, and €4, 002 per patient for the beta-lactam monotherapy, beta-lactam/macrolide combination, and fluoroquinolone monotherapy strategy, respectively. CMA results were €106 (95% CI €-697 to €754) for the beta-lactam/macrolide combination strategy and €-278 (95%CI €-991 to €396) for the fluoroquinolone monotherapy strategy, both compared to the beta-lactam monotherapy strategy. The ICER was not statistically significantly different between the strategies. Other perspectives yielded similar results. Conclusions There were no significant differences in cost-effectiveness of strategies of preferred antibiotic treatment of CAP on non-ICU wards with either beta-lactam monotherapy, beta-lactam/macrolide combination therapy, or fluoroquinolone monotherapy. Trial registration The trial was registered with ClinicalTrials.gov, numberNCT01660204, on May 2nd, 2012.