title: [Cost-effectiveness analysis of ambulatory treatment for adult patients with community-acquired pneumonia: according to Japanese Respiratory Society guidelines].
abstract: The Japanese Respiratory Society has recently formulated practice guidelines for the management of adult patients with community-acquired pneumonia. The guidelines recommend the use of various oral antibiotics at individual physicians' discretion. We compared the cost-effectiveness of amoxicillin/clavulanate (AMPC/CVA), azithromycin (AZM), clarithromycin (CAM), cefdinir (CFDN), levofloxacin (LVFX), and minocycline (MINO), when used on an ambulatory basis. We performed a formal cost-effectiveness analysis from the perspective of direct cost payers in the framework of the Japanese medical system. Outcomes considered were quality-adjusted life days (QALD), costs per patient, and incremental costs per quality-adjusted life year (QALY) gained. Under baseline conditions, the effectiveness of MINO, AZM, CAM, and LVFX were on a par and higher than that of AMPC/CVA or CFDN by 125-290.5 QALD. The least expensive antibiotic was MINO (55,070 to 59,208 yen), followed by AZM (56,049 to 60,188 yen), CAM (56,171 to 60,309 yen), LVFX (61,988 to 66,127 yen). AMPC/CVA (122,432 to 133,797 yen), and CFDN (123,375 to 134,649 yen). Thus, MINO, AZM, and CAM were cost-effective antibiotics for adults with community-acquired pneumonia. Sensitivity analyses revealed that the initial success rate of each antibiotic was crucial in determining cost-effectiveness. When the number of times antibiotics are taken in a day and the period of therapy were taken into account, AZM was most beneficial with 917,179-1,152,694 yen (US$ 7,643-9,606) per additional QALY over MINO in patients without comorbidity. This result, however, was not applicable to patients with chronic lung disease. MINO was the least expensive and the most cost-effective in empirically treating adult patients with community-acquired pneumonia on an ambulatory basis. AZM provides a higher quality of life for adults without comorbidity with generally acceptable marginal cost.
authors.affiliation: Department of General Medicine and Clinical Epidemiology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Koyama
authors.forename: Takuro
authors.initials: T
authors.lastname: Shimbo
authors.forename: Tsuguya
authors.initials: T
authors.lastname: Fukui
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics*; D017714:Community-Acquired Infections / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy*; D017410:Practice Guidelines as Topic
chemical_list: D000900:Anti-Bacterial Agents