Model to evaluate the cost-effectiveness of different antibiotics in the management of community-acquired pneumonia in Germany

Summary

This study investigated the primary cost-drivers and determinants of the cost-effectiveness of antibacterial treatment of community-acquired pneumonia (CAP) in Germany. It assessed the health care costs and consequences related to treatment initiated in the community using macrolides, fluoroquinolones, and cephalosporins. Patients were categorised according to disease severity. Decision analysis was used to consider the clinical and economic consequences of various treatment options from first-line treatment initiated by a primary care physician in the community to success or failure after third-line treatment in hospital.

The key cost drivers were the clinical success/failure rates of first-line treatment and, in moderate CAP, the cost per day of hospitalisation. Thus, antibiotics with the cheapest purchase price are not necessarily the most cost-effective treatment. This is because the extra costs associated with treatment failure, especially in more severely ill patients, can be much greater than the acquisition costs of the first-line antibiotic. Of the antibiotics considered, none was consistently found to be the most cost-effective across the full range of scenarios investigated. However, in moderate CAP the fluoroquinolones and cephalosporins were generally more cost-effective than the macrolides. Given the high cost associated with hospitalisation, and the low mortality rates in low-risk patients with mild and moderate CAP, successful outcomes and health care cost savings can be achieved if such patients receive appropriate antibiotics as first-line treatment in the community.

Keywords: :

• CAP
• decision tree model
• cost-effectiveness
• antibiotics
• antimicrobial resistance
• patient compliance