Cost-effectiveness of ceftriaxone in the treatment of community-acquired pneumonia in adult hospital patients. A pharmaco-economic study based on a meta-analysis.
OBJECTIVE
A retrospective analysis was conducted to assess the cost-effectiveness of four intravenous antibiotic treatment regimens in the treatment of severe community-acquired pneumonia (CAP) in adults in a private hospital setting. The study compared some third-generation cephalosporin regimens with a second-generation cephalosporin and an amoxicillin/clavulanic acid (co-amoxiclav) regimen to investigate published South African treatment guidelines from a pharmaco-economic point of view.


METHODS
A pharmaco-economic model of local costs, from a payer perspective, was based on the results of a meta-analysis of clinical papers from peer-reviewed journals. The study compared intravenous (i.v.) ceftriaxone (2 g once daily), cefotaxime (i.v. 2 g 3 times a day), cefuroxime (i.v. 750 mg 3 times a day, followed by 500 mg orally 3 times a day) and amoxicillin/clavulanic acid (1.2 g intravenously 3 times a day, followed by 625 mg orally 3 times a day) [corrected].


RESULTS
An analysis of the odds ratios (ORs) of all two-way comparisons indicated that ceftriaxone ensured significantly higher probabilities of successful outcomes than the other antibiotic treatment regimens (ORs in the order of two were indicated). The pharmaco-economic results suggested that the ceftriaxone treatment regimen was the most cost-effective in the hospital treatment of CAP in adult patients. These results proved to be robust across sensitivity analyses for success rates and treatment days. A sensitivity analysis testing the assumption that patients could be discharged once the oral treatment was initiated indicated that the amoxicillin/clavulanic acid and cefuroxime treatment arms were more cost-effective. The clinical validity of such an assumption is questionable.


CONCLUSIONS
Despite the conservative approach followed in terms of ceftriaxone data, both the clinical results and cost-effectiveness supported the use of ceftriaxone in the treatment of CAP in adults in the hospital setting.
Wessels
F
F
Outcomes Consultants, Monument Park, Pretoria.
Anderson
A N
AN
Ebrahim
O
O
D000328:Adult; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000191:economics / Q000627:therapeutic use; D002439:Cefotaxime / Q000191:economics / Q000627:therapeutic use; D002443:Ceftriaxone / Q000191:economics* / Q000627:therapeutic use; D002444:Cefuroxime / Q000191:economics / Q000627:therapeutic use; D002511:Cephalosporins / Q000191:economics* / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination / Q000191:economics / Q000627:therapeutic use; D017721:Hospital Costs; D006801:Humans; D007223:Infant; D007902:Length of Stay; D016017:Odds Ratio; D018410:Pneumonia, Bacterial / Q000188:drug therapy*; D012189:Retrospective Studies; D013019:South Africa; D016896:Treatment Outcome
D002511:Cephalosporins; D019980:Amoxicillin-Potassium Clavulanate Combination; D002443:Ceftriaxone; D002439:Cefotaxime; D002444:Cefuroxime