title: Cost-effectiveness of antibiotic treatment strategies for community-acquired pneumonia: results from a cluster randomized cross-over trial.
abstract: To determine the cost-effectiveness of strategies of preferred antibiotic treatment with beta-lactam/macrolide combination or fluoroquinolone monotherapy compared to beta-lactam monotherapy.
  
  
  
  Costs and effects were estimated using data from a cluster-randomized cross-over trial of antibiotic treatment strategies, primarily from the reduced third payer perspective (i.e. hospital admission costs). Cost-minimization analysis (CMA) and cost-effectiveness analysis (CEA) were performed using linear mixed models. CMA results were expressed as difference in costs per patient. CEA results were expressed as incremental cost-effectiveness ratios (ICER) showing additional costs per prevented death.
  
  
  
  A total of 2,283 patients were included. Crude average costs within 90 days from the reduced third payer perspective were €4,294, €4,392, and €4,002 per patient for the beta-lactam monotherapy, beta-lactam/macrolide combination, and fluoroquinolone monotherapy strategy, respectively. CMA results were €106 (95% CI €-697 to €754) for the beta-lactam/macrolide combination strategy and €-278 (95%CI €-991 to €396) for the fluoroquinolone monotherapy strategy, both compared to the beta-lactam monotherapy strategy. The ICER was not statistically significantly different between the strategies. Other perspectives yielded similar results.
  
  
  
  There were no significant differences in cost-effectiveness of strategies of preferred antibiotic treatment of CAP on non-ICU wards with either beta-lactam monotherapy, beta-lactam/macrolide combination therapy, or fluoroquinolone monotherapy.
  
  
  
  The trial was registered with ClinicalTrials.gov, number NCT01660204 , on May 2nd, 2012.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Cornelis H
authors.initials: CH
authors.lastname: van Werkhoven
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. d.f.postma@umcutrecht.nl.|Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. d.f.postma@umcutrecht.nl.|Department of Internal Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands. d.f.postma@umcutrecht.nl.
authors.forename: Douwe F
authors.initials: DF
authors.lastname: Postma
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Marie-Josee J
authors.initials: MJ
authors.lastname: Mangen
authors.affiliation: Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
authors.forename: Jan Jelrik
authors.initials: JJ
authors.lastname: Oosterheert
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.|Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Marc J M
authors.initials: MJ
authors.lastname: Bonten
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000191:economics; D003362:Cost-Benefit Analysis; D018592:Cross-Over Studies; D004359:Drug Therapy, Combination; D005260:Female; D024841:Fluoroquinolones / Q000191:economics / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D018942:Macrolides / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000191:economics; D047090:beta-Lactams / Q000191:economics / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D018942:Macrolides; D047090:beta-Lactams
keywords: Beta-lactam macrolide; Community acquired pneumonia; Cost-effectiveness; Fluoroquinolone