Cost-effectiveness of empirical prescribing of antimicrobials in community-acquired pneumonia in three countries in the presence of resistance.
OBJECTIVE
To assess the cost-effectiveness of empirical outpatient treatment options for community-acquired pneumonia (CAP) in France, the USA and Germany, representing high, moderate and low antimicrobial resistance prevalence, respectively.


METHODS
A decision analytic model was developed for mild-to-moderate CAP outpatient treatment. Treatment algorithms incorporated follow-up after treatment failure due to resistance or other reasons. First-line treatment included moxifloxacin, beta-lactams, macrolides or doxycycline; second-line treatment used a different antimicrobial class. Country-specific resistance and co-resistance prevalences to first- and second-line therapy for the major CAP pathogens were derived from surveillance studies. Clinical failure rates due to antimicrobial-susceptible and -resistant pathogens were obtained from the literature or estimated. Total costs were estimated using standard sources and a third-party payer perspective. Outcome measures included first-line clinical failures avoided, second-line treatments avoided and hospitalizations avoided. Incremental cost-effectiveness ratios (ICERs) were calculated.


RESULTS
First-line moxifloxacin treatment followed by co-amoxiclav dominated all other treatments in France, the USA and in Germany for all outcome measures. Sensitivity analyses maintained moxifloxacin dominance in France and the USA but affected ICERs in some cases in Germany.


CONCLUSIONS
Antimicrobial resistance/spectrum have a significant impact on outcomes and costs in empirical outpatient CAP treatment. Despite low acquisition costs for generic antibiotics, first-line treatment effective against the major CAP pathogens, including strains resistant to other antimicrobials, resulted in better clinical outcomes in all countries and lower treatment costs for all.
Martin
Monique
M
i3 Innovus, Beaufort House, Cricket Field Road, Uxbridge UB8 1QG, UK. mmartin@innovus.com
Quilici
Sibilia
S
File
Thomas
T
Garau
Javier
J
Kureishi
Amar
A
Kubin
Maria
M
D000553:Ambulatory Care; D000890:Anti-Infective Agents / Q000191:economics / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D011307:Drug Prescriptions / Q000191:economics*; D004352:Drug Resistance, Microbial; D004363:Drug Utilization / Q000191:economics*; D005602:France; D005858:Germany; D006801:Humans; D018410:Pneumonia, Bacterial / Q000188:drug therapy*; D014481:United States
D000890:Anti-Infective Agents