Cost-effectiveness analysis of empiric antibiotics in hospitalized community-acquired Pneumonia

Authors

  • Yeni Farida Department of Pharmacy, Faculty of Mathematics and Science, Universitas Sebelas Maret
  • Qisty Aulia Khoiry Department of Pharmacy, Faculty of Mathematics and Science, Universitas Sebelas Maret
  • Muchtar Hanafi Department of Pharmacy, Faculty of Mathematics and Science, Universitas Sebelas Maret
  • Maryani Maryani Department of Pharmacy, Faculty of Mathematics and Science, Universitas Sebelas Maret

DOI:

https://doi.org/10.12928/pharmaciana.v12i1.21376

Keywords:

effectiveness, empirical antibiotics, community-acquired pneumonia, cost-effective

Abstract

Community-Acquired Pneumonia (CAP) remains an important infectious disease due to its impact on patient outcomes.  This study aimed to investigate the clinical outcome and especially costs of hospitalization for community-acquired pneumonia (CAP) concerning empirical antibiotics. This research was conducted to estimate the cost-effectiveness of levofloxacin, ceftriaxone, and a combination of ceftriaxone and azithromycin aiming to improve the clinical outcome of CAP. A retrospective observational study was conducted in secondary care, University Hospital in Surakarta, Central Java, Indonesia. The study enrolled all CAP patients hospitalized in the period January until December 2018, with ages≥ 18 years old, and at least used antibiotic for three days. We compared cost-effectiveness, as measured by total cost and proportion of patients successfully treated, of 3 empirical antibiotics for inpatient CAP, involving ceftriaxone, levofloxacin, or combination ceftriaxone + azithromycin. Our analyses were conducted based on a healthcare perspective. In all groups were analyzed based on severity classification (Pneumonia Severity Index score). The use of levofloxacin instead of ceftriaxone improved clinical response, but it is more expensive. Levofloxacin was the most cost-effective based on ACER value. Treatment using a combination of ceftriaxone + azithromycin was more expensive without added benefit. Based on this study, the use of levofloxacin as the first-line therapy for CAP could be maintained because it was more cost-effective than other alternatives. Since the limitations, a study on a broader population is needed to confirm these findings.

References

Alavi-Moghaddam, M., Bakhshi, H., Rezaei, B., & Khashayar, P. (2013). Pneumonia severity index compared to CURB-65 in predicting the outcome of community acquired pneumonia among patients referred to an Iranian emergency. Brazilian Journal of Infectious Diseases, 17(2), 179–183. https://doi.org/10.1016/J.BJID.2012.10.012

Azmi, S., Aljunid, S. M., Maimaiti, N., Ali, A.-A., Muhammad Nur, A., De Rosas-Valera, M., Encluna, J., Mohamed, R., Wibowo, B., Komaryani, K., & Roberts, C. (2016). Assessing the burden of pneumonia using administrative data from Malaysia, Indonesia, and the Philippines. International Journal of Infectious Diseases, 49, 87–93. https://doi.org/10.1016/J.IJID.2016.05.021

Burhan, E., Isbaniyah, F., Susanto, A. D., & Et.al. (2020). Pneumonia Covid-19 Diagnosis dan Penatalaksanaan di Indonesia. Persatuan Dokter Paru Indonesia

Cillóniz, C., Ewig, S., Polverino, E., Marcos, M. A., Esquinas, C., Gabarrús, A., Mensa, J., & Torres, A. (2011). Microbial aetiology of community-acquired pneumonia and its relation to severity. Thorax, 66(4), 340–346. https://doi.org/10.1136/thx.2010.143982

Corrales-Medina, V. F., Suh, K. N., Rose, G., Chirinos, J. A., Doucette, S., Cameron, D. W., & Fergusson, D. A. (2011). Cardiac Complications in Patients with Community-Acquired Pneumonia: A Systematic Review and Meta-Analysis of Observational Studies. PLoS Medicine, 8(6), e1001048. https://doi.org/10.1371/journal.pmed.1001048

Elflein, J. (2018, August). Pneumonia patient hospital stay duration by age and setting U.S. 2014 | Statista. https://www.statista.com/statistics/913891/pneumonia-patient-average-hospital-stay-length-icu/

Ewig, S., Höffken, G., Kern, W., Rohde, G., Flick, H., Krause, R., Ott, S., Bauer, T., Dalhoff, K., Gatermann, S., Kolditz, M., Krüger, S., Lorenz, J., Pletz, M., de Roux, A., Schaaf, B., Schaberg, T., Schütte, H., & Welte, T. (2016). Management of Adult Community-Acquired Pneumonia and Prevention– Update 2016. Pneumologie, 70(03), 151–200. https://doi.org/10.1055/s-0042-101873

Farida, Y., Puspita, K., & Yusvida, Z. (2019). Empirical Antibiotics Study on Pneumonia in Intensive Care Unit. Proceedings of the 1st Muhammadiyah International Conference on Health and Pharmaceutical Development (MICH-PhD 2018), 36, 48–53. https://doi.org/10.5220/0008239200480053

File, T. M., Bartlett, J. G., & Thorner, A. R. (2021). Treatment of community-acquired pneumonia in adults who require hosp ... Treatment of community-acquired pneumonia in adults who require hosp ... UptoDate. https://www.uptodate.com/contents/treatment-of-community-acquired-pneumonia-in-adults-who-require-hospitalization

Ho, P.-L., Cheng, V. C.-C., & Chu, C.-M. (2009). Antibiotic Resistance in Community-Acquired Pneumonia Caused by Streptococcus pneumoniae , Methicillin-Resistant Staphylococcus aureus , and Acinetobacter baumannii. Chest, 136(4), 1119–1127. https://doi.org/10.1378/chest.09-0285

Izadi, M., Dadsetan, B., Najafi, Z., Jafari, S., Mazaheri, E., Dadras, O., Heidari, H., SeyedAlinaghi, S., & Voltarelli, F. (2018). Levofloxacin Versus Ceftriaxone and Azithromycin Combination in the Treatment of Community Acquired Pneumonia in Hospitalized Patients. Recent Patents on Anti-Infective Drug Discovery, 13(3), 228–239. https://doi.org/10.2174/1574891x13666181024154526

Kaptoge, S., Seshasai, S. R. K., Gao, P., Freitag, D. F., Butterworth, A. S., Borglykke, A., Angelantonio, E. Di, Gudnason, V., Rumley, A., Lowe, G. D. O., Jørgensen, T., & Danesh, J. (2014). Editor’s choice: Inflammatory cytokines and risk of coronary heart disease: new prospective study and updated meta-analysis. European Heart Journal, 35(9), 578. https://doi.org/10.1093/eurheartj/eht367

Kemenkes, D. J. B. K. dan A. K. (2013). Pedoman Penerapan Kajian Farmakoekonomi (P. Sarnianto, Z. Fadia, & E. Gusnellyanti (eds.); 1st ed.). Kementrian Kesehatan Republik Indonesia

Konomura, K., Nagai, H., & Akazawa, M. (2017). Economic burden of community-acquired pneumonia among elderly patients: a Japanese perspective. Pneumonia 2017 9:1, 9(1), 1–10. https://doi.org/10.1186/S41479-017-0042-1

Kosar, F., Alici, D. E., Hacibedel, B., Arpınar Yigitbas, B., Golabi, P., & Cuhadaroglu, C. (2017). Burden of community-acquired pneumonia in adults over 18 y of age. Human Vaccines and Immunotherapeutics, 13(7). https://doi.org/10.1080/21645515.2017.1300730

Kourkouta, L., Kotsiftopoulos, C. H., Papageorgiou, M., Iliadis, C. H., & Monios, A. (2017). The Rational Use of Antibiotics Medicine. Journal of Healthcare Communication, 2(3), 27–30

Madhu, S., Augustine, S., Ravi Kumar, Y. S., Kauser M. M., K., Kumar, S. R. V., & Jayaraju, B. S. (2017). Comparative study of CURB-65, Pneumonia Severity Index and IDSA/ATS scoring systems in community acquired pneumonia in an Indian tertiary care setting. International Journal of Advances in Medicine, 4(3), 693. https://doi.org/10.18203/2349-3933.ijam20172088

Mandell, L. A., Wunderink, R. G., Anzueto, A., Bartlett, J. G., Campbell, G. D., Dean, N. C., Dowell, S. F., File, T. M., Musher, D. M., Niederman, M. S., Torres, A., & Whitney, C. G. (2007). Infectious Diseases Society of America / American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. 44(Suppl 2). https://doi.org/10.1086/511159

McKinnell, J. A., Corman, S., Patel, D., Leung, G. H., Gordon, L. M., & Lodise, T. P. (2018). Effective Antimicrobial Stewardship Strategies for Cost-effective Utilization of Telavancin for the Treatment of Patients With Hospital-acquired Bacterial Pneumonia Caused by Staphylococcus aureus. Clinical Therapeutics, 40(3), 406-414.e2. https://doi.org/10.1016/j.clinthera.2018.01.010

Metlay, J. P., Waterer, G. W., Long, A. C., Anzueto, A., Brozek, J., Crothers, K., Cooley, L. A., Dean, N. C., Fine, M. J., Flanders, S. A., Griffin, M. R., Metersky, M. L., Musher, D. M., Restrepo, M. I., & Whitney, C. G. (2019). Diagnosis and Treatment of Adults with Community-acquired Pneumonia. American Journal of Respiratory and Critical Care Medicine, 200(7), e45–e67. https://doi.org/10.1164/rccm.201908-1581ST

Murter, F., Dimond, K., Gilstrap, C., Grubbs, R., Vowell, C., Maldonado, C., & Jansen, J. W. (2019). Ceftriaxone Monotherapy vs. Ceftriaxone Plus Azithromycin for the Treatment of Community-Acquired Pneumonia in Hospitalized, Non-ICU Patients. Open Forum Infectious Diseases, 6(Suppl 2), S748. https://doi.org/10.1093/OFID/OFZ360.1877

Nalang, A., Citraningtyas, G., & Lolo, W. A. (2018). Analisis Efektivitas Biaya ( Cost Effectiveness Analysis ) Pengobatan Pneumonia Menggunakan Antibiotik. Pharmacon, 7(3), 321–329. https://doi.org/10.35799/pha.7.2018.20599

Niederman, M., Chastre, J., Solem, C., Wan, Y., Gao, X., Myers, D., Haider, S., Li, J., & Stephens, J. (2014). Health economic evaluation of patients treated for nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus: secondary analysis of a multicenter randomized clinical trial of vancomycin and linezolid. Clinical Therapeutics, 36(9), 1233–1243. https://doi.org/10.1016/j.clinthera.2014.06.029

Noguchi, S., Yatera, K., Kawanami, T., Fujino, Y., Moro, H., Aoki, N., Komiya, K., Kadota, J., Shime, N., Tsukada, H., Kohno, S., & Mukae, H. (2017). Pneumonia Severity Assessment Tools for Predicting Mortality in Patients with Healthcare-Associated Pneumonia: A Systematic Review and Meta-Analysis. Respiration, 93(6), 441–450. https://doi.org/10.1159/000470915

Queen, M. A., Myers, A. L., Hall, M., Shah, S. S., Williams, D. J., Auger, K. A., Jerardi, K. E., Statile, A. M., & Tieder, J. S. (2014). Comparative Effectiveness of Empiric Antibiotics for Community-Acquired Pneumonia. Pediatrics, 133(1), e23–e29. https://doi.org/10.1542/peds.2013-1773

Ramirez, J., Wiemken, T., Peyrani, P., Arnold, F., Kelley, R., Mattingly, W., Nakamatsu, R., Pena, S., Guinn, B., Furmanek, Persaud, A., Raghuram, A., F, F., L, B., R, B., R, F.-B., R, C., J, B., C, V., … RM, C. (2017). Adults Hospitalized With Pneumonia in the United States: Incidence, Epidemiology, and Mortality. Clinical Infectious Diseases : An Official Publication of the Infectious Diseases Society of America, 65(11), 1806–1812. https://doi.org/10.1093/CID/CIX647

Restrepo, M. I., & Reyes, L. F. (2018). Pneumonia as a cardiovascular disease. Respirology, 23(3), 250–259. https://doi.org/10.1111/RESP.13233

Ruiz-Ramos, J., Frasquet, J., Romá, E., Luis Poveda-Andres, J., Salavert-Leti, M., Castellanos, A., Ramirez, P., & Rom, E. (2017). Cost-effectiveness analysis of implementing an antimicrobial stewardship program in critical care units. https://doi.org/10.1080/13696998.2017.1311903

Sato, R., Gomez, G., Stephanie, R., & Pinsky, B. (2013). Community-Acquired Pneumonia Episode Costs by Age and Risk in Commercially Insured US Adults Aged ‡ 50 Years. Appl Health Econ Health Policy (2013), 11, 251–258. https://doi.org/10.1007/s40258-013-0026-0

Smith, M., Fee, C., Mace, S., Maughan, B., Perkins, J., Kaji, A., & Wolf, S. (2021). Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Community-Acquired Pneumonia. Annals of Emergency Medicine, 77(1), e1–e57. https://doi.org/10.1016/j.annemergmed.2020.10.024

Sriram, S., Aiswaria, V., Cijo, A., & Mohankumar, T. (2013). Antibiotic sensitivity pattern and cost-effectiveness analysis of antibiotic therapy in an Indian tertiary care teaching hospital. Journal of Research in Pharmacy Practice, 2(2), 70–74. https://doi.org/10.4103/2279-042x.117386

Stupka, J. E., Mortensen, E. M., Anzueto, A., & Restrepo, M. I. (2009). Community-acquired pneumonia in elderly patients. Aging Health, 5(6), 763–774. https://doi.org/10.2217/ahe.09.74

Suratini, S., Sauriasari, R., Hamadah, F., & Kusumaeni, T. (2017). Cost-effectiveness analysis of ceftriaxone-azithromycin combination and single levofloxacin as empirical antibiotics in community-acquired pneumonia inpatients at persahabatan hospital. Asian Journal of Pharmaceutical and Clinical Research, 10(Special Issue October), 118–123. https://doi.org/10.22159/ajpcr.2017.v10s5.23112

Walger, P. (2016). [Rational use of antibiotics]. Der Internist, 57(6), 551–568. https://doi.org/10.1007/S00108-016-0071-5

Wongsurakiat, P., & Chitwarakorn, N. (2019). Severe community-acquired pneumonia in general medical wards: outcomes and impact of initial antibiotic selection. BMC Pulmonary Medicine, 19(1). https://doi.org/10.1186/S12890-019-0944-1

Wunderink, R. G., & Yin, Y. (2016). Antibiotic Resistance in Community-Acquired Pneumonia Pathogens.

Xiao, K., Su, L., Han, B., Yan, P., Yuan, N., Deng, J., Li, J., & Xie, L. (2013). Analysis of the severity and prognosis assessment of aged patients with community-acquired pneumonia: a retrospective study. Journal of Thoracic Disease, 5(5), 626–633. https://doi.org/10.3978/J.ISSN.2072-1439.2013.09.10

Yeh, J.-J., Lin, C.-L., & Kao, C.-H. (2019). Relationship between pneumonia and cardiovascular diseases: A retrospective cohort study of the general population. European Journal of Internal Medicine, 59, 39–45. https://doi.org/10.1016/j.ejim.2018.08.003

Downloads

Published

2022-03-10

Issue

Vol. 12 No. 1 (2022): Pharmaciana

Section

Clinical and Community Pharmacy

License

Authors who publish with Pharmaciana agree to the following terms:

  1. Authors retain copyright and grant the journal the right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC BY-SA 4.0) that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal. 
  2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
  3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.