TY - JOUR
T1 - Cost-effectiveness of antibiotic treatment strategies for community-acquired pneumonia
T2 - results from a cluster randomized cross-over trial
AU - van Werkhoven, Cornelis H
AU - Postma, Douwe F
AU - Mangen, Marie-Josee J
AU - Oosterheert, Jan Jelrik
AU - Bonten, Marc J M
N1 - Publisher Copyright:
© 2017 The Author(s).
PY - 2017/1/10
Y1 - 2017/1/10
N2 - BACKGROUND: To determine the cost-effectiveness of strategies of preferred antibiotic treatment with beta-lactam/macrolide combination or fluoroquinolone monotherapy compared to beta-lactam monotherapy.METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.TRIAL REGISTRATION: The trial was registered with ClinicalTrials.gov, number NCT01660204 , on May 2nd, 2012.
AB - BACKGROUND: To determine the cost-effectiveness of strategies of preferred antibiotic treatment with beta-lactam/macrolide combination or fluoroquinolone monotherapy compared to beta-lactam monotherapy.METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.TRIAL REGISTRATION: The trial was registered with ClinicalTrials.gov, number NCT01660204 , on May 2nd, 2012.
KW - Beta-lactam macrolide, Fluoroquinolone, Cost-effectiveness, Community acquired pneumonia
U2 - 10.1186/s12879-016-2179-6
DO - 10.1186/s12879-016-2179-6
M3 - Article
C2 - 28068956
SN - 1471-2334
VL - 17
JO - BMC Infectious Diseases [E]
JF - BMC Infectious Diseases [E]
IS - 1
M1 - 17:52
ER -