Comparative Clinical and Pharmacoeconomic Analysis of Different Antimicrobial Treatment Regimens in Hospitalized Patients with Community-Acquired Pneumonia

Clinical Microbiology and Antimicrobial Chemotherapy. 2012; 14(3):209-221

​ Rachina S.A., Kozlov R.S., Samuylo E.K., Makushin D.A.
community-acquired pneumonia health economics azithromycin levofloxacin
Section
Diseases and Pathogens
Type
Journal article
Publication
Clinical Microbiology and Antimicrobial Chemotherapy. 2012; 14(3):209-221

Objective.

To conduct a cost-effectiveness analysis of combination of azithromycin with b-lactams (cefotaxime, ceftriaxone or amoxicillin/clavulanic acid) vs levofloxacin in hospitalized adults with community-acquired pneumonia (CAP).

Materials and Methods.

We performed standard search and meta-analysis of prospective clinical trials (CT) to compare clinical success rate and tolerability of regimens of antibacterial therapy (ABT) under the investigation. Direct medical costs (DC) including cost of ABT and hospital stay were calculated from the perspective of Smolensk Regional Clinical Hospital and Central Clinical Hospital of Russian Academy of Sciences. Costs of ABT and DC were analysed both for original and generic antibiotics (AB). The length of hospital stay corresponded to routine clinical practice in base case scenario and duration of ABT in CT in alternative scenario. Uncertainty was investigated in one and two-way sensitivity analyses.

Results.

Two comparative CT of azithromycin + ceftriaxone +/– cefuroxime (Group 1) vs levofloxacin (Group 2) were found. Meta-analysis showed similar overall clinical success rates as well as tolerability profile of combination ABT and levofloxacin monotherapy in hospitalized adults with CAP. Cost of ABT with original AB in Smolensk Regional Clinical Hospital in Group 1 was 4056.7 rubles, in Group 2 – 7010.3 rubles, DC – 17561.1 and 20514.7 rubles in base case scenario, 13027.5 and 17813.8 rubles, respectively, in alternative scenario; as for Central Clinical Hospital of Russian Academy of Sciences cost of ABT in Group 1 was 4005.3 rubles, in Group 2 – 6964.8 rubles, DC – 17165.3 and 20124.8 rubles in base case scenario, 12747.3 and 17492.8 rubles, respectively, in alternative scenario. The results were insensitive to variables of interest. Cost of ABT with generics in Smolensk Regional Clinical Hospital in Group 1 was 1871.8 rubles, in Group 2 – 1611.5 rubles, DC – 15376.2 and 15115.9 rubles in base case scenario, 10842.6 and 12415.0 rubles, respectively, in alternative scenario; in Central Clinical Hospital of Russian Academy of Sciences cost of ABT in Group 1 was 1859.6 rubles, in Group 2 – 1694.8 rubles, DC – 15019.6 and 14854.8 rubles in base case scenario, 10601.6 and 12222.8 rubles, respectively, in alternative scenario. The results were sensitive to length of intravenous antibiotic therapy and length of hospital stay changes.

Conclusions.

Combination ABT with azithromycin + ceftriaxone +/– cefuroxime is more cost effective compared to levofloxacin monotherapy for hospitalized adults with CAP if original AB are used. The choice of less costly regimen of ABT for generics depends on duration of intravenous AB use and length of hospital stay.

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