A cost-effectiveness analysis of antimicrobial treatment of community-acquired pneumonia taking into account resistance in Belgium.
OBJECTIVE
This article assesses the cost-effectiveness of outpatient antimicrobial treatment of community-acquired pneumonia (CAP) taking into account resistance in Belgium.


METHODS
Our decision analytic model focused on mild to moderate CAP, but did not consider severe CAP. Treatment pathways reflected empirical treatment initiated in the absence of data on CAP aetiology. First-line treatment consisted of moxifloxacin, co-amoxiclav, cefuroxime or clarithromycin. If first-line treatment was unsuccessful, patients were either hospitalised or second-line treatment with a different antimicrobial was initiated. Clinical failure rates were obtained from the published literature or expert opinion. Costs were calculated using published sources from the third-party payer perspective.


METHODS
Effectiveness measures included first-line clinical failure avoided, second-line treatment avoided, hospitalisation avoided and death avoided. Healthcare costs were included, but costs of productivity loss were not considered.


RESULTS
Costs of treating a CAP episode amounted to 144E with moxifloxacin/co-amoxiclav; 222E with co-amoxiclav/clarithromycin; 211E with cefuroxime/moxifloxacin; and 193E with clarithromycin/moxifloxacin. The rate of first-line failure was 5%, 16%, 19% and 18% for these four treatment strategies, respectively. The rate of second-line treatment amounted to 4%, 13%, 16% and 15%, respectively. The hospitalisation rate was 1%, 4%, 4% and 4%, respectively. The death rate was 0.01%, 0.04%, 0.03% and 0.03%, respectively. Sensitivity analyses supported the dominance of moxifloxacin/co-amoxiclav in nearly all scenarios.


CONCLUSIONS
First-line treatment of CAP patients with moxifloxacin followed by co-amoxiclav or hospitalisation if required was more effective and less costly as compared with first-line treatment with co-amoxiclav, cefuroxime or clarithromycin.
Martin
Monique
M
i3 Innovus, Uxbridge, UK. monique.martin@i3innovus.com
Moore
Lee
L
Quilici
Sibilia
S
Decramer
Marc
M
Simoens
Steven
S
D000658:Amoxicillin / Q000191:economics / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use*; D001372:Aza Compounds / Q000191:economics / Q000627:therapeutic use; D001530:Belgium; D002444:Cefuroxime / Q000191:economics / Q000627:therapeutic use; D017291:Clarithromycin / Q000191:economics / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D016527:Drug Costs; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D024841:Fluoroquinolones; D006801:Humans; D000077266:Moxifloxacin; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000191:economics* / Q000382:microbiology; D011804:Quinolines / Q000191:economics / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D000658:Amoxicillin; D017291:Clarithromycin; D002444:Cefuroxime; D000077266:Moxifloxacin