COST-EFFECTIVENESS ANALYSIS OF CEFTRIAXONE-AZITHROMYCIN COMBINATION AND SINGLE LEVOFLOXACIN AS EMPIRICAL ANTIBIOTICS IN COMMUNITY-ACQUIRED PNEUMONIA INPATIENTS AT PERSAHABATAN HOSPITAL

Sri Suratini; Rani Sauriasari; Firzawati Hamadah

doi:10.22159/ajpcr.2017.v10s5.23112

Authors

Sri Suratini Department of Pharmacy, Faculty of Pharmacy, Universitas Indonesia, Depok, Indonesia.
Rani Sauriasari Department of Pharmacy, Faculty of Pharmacy, Universitas Indonesia, Depok, Indonesia
Firzawati Hamadah Department of Health, Regional General Hospital Bekasi, Bekasi, Indonesia. 3Department of Pharmacy, Persahabatan Hospital, Jakarta, Indonesia

DOI:

https://doi.org/10.22159/ajpcr.2017.v10s5.23112

Keywords:

Cost-effectiveness, Antibiotic, Community-acquired pneumonia, Ceftriaxone, Azithromycin, Levofloxacin

Abstract

Â

Â Objective: Community-acquired pneumonia (CAP) is one of the most common infectious diseases. Its prevalence is especially concerning, as the disease severely impacts health and has a high mortality rate. Although antibiotics have been used to treat CAP, their use is often costly and inefficient. Thus, this study aimed to determine the cost-effectiveness of using ceftriaxone-azithromycin combination and single levofloxacin as empirical antibiotics to treat patients with CAP. Cost-effectiveness was analyzed by comparing the direct total medical cost to clinical effectiveness, which was indicated by the respective success rates in each treatment group.

Methods: This study was conducted at Persahabatan Hospital in Jakarta and employed an observational study design, where data were obtained retrospectively from the secondary data contained in medical records for 2014-2016. A total of 100 patients were included in the analysis, with 64 patients using intravenous (iv) antibiotic ceftriaxone and oral azithromycin and 36 patients using iv single levofloxacin.

Results: The median costs of antibiotics were significantly different between the ceftriaxone-azithromycin group and the levofloxacin group: Rp.130.756 and Rp.286.952, respectively. The direct total medical cost in the ceftriaxone-azithromycin group (Rp.6.494.998) was higher than that of the single levofloxacin group (Rp.5.444.242). The success rate was 95.3% in the ceftriaxone-azithromycin group and 97.2% in the levofloxacin group, but there were no significant differences between the two groups. The medians for the length of stay (LOS) and length of stay antibiotic-related (LOSAR) measures in the levofloxacin group were 6 and 5 days, which were shorter than the LOS and LOSAR medians in the ceftriaxone-azithromycin group: 7 days and 6 days, respectively. The average cost-effectiveness ratio value in the levofloxacin group was 56.011% effectiveness lower than that of the ceftriaxone-azithromycin group, which was Rp.68.153% effectiveness.

Conclusions: Based on these results, it can be concluded that levofloxacin is more cost-effective than a combination of ceftriaxone-azithromycin for treating CAP.

Downloads

Download data is not yet available.

References

Menendez R, Reyes S, Martinez R, de la Cuadra P, Valles JM, Vallterra J. Economic evaluation of adherence to treatment guidelines in non-intensive care pneumonia. Eur Respir J 2007;29:751-6.

Alldredge K, Corelli RL, Ernst ME. Applied Therapeutics, the Clinical use of Drugs. 10th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013.

Vigg A. Severe community acquired pneumonia (SCAP). Apollo Med 2016;13(1):17-9.

Indonesian Pulmonologist Association. Pneumonia Komunitas. Jakarta: Pedoman Diagnosis dan Penatalaksanaan di Indonesia; 2014.

Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44 Suppl 2:S27-72.

Bhavnani SM, Ambrose PG. Cost-effectiveness of oral gemifloxacin versus intravenous ceftriaxone followed by oral cefuroxime with/ without a macrolide for the treatment of hospitalized patients with community-acquired pneumonia. Diagn Microbiol Infect Dis 2008;60(1):59-64.

Dresser LD, Niederman MS, Paladino JA. Cost-effectiveness of gatifloxacin vs ceftriaxone with a macrolide for the treatment of community-acquired pneumonia. Chest 2001;119(5):1439-48.

Shea KM, Weycker D, Stevenson AE, Strutton DR, Pelton SI. Modeling the decline in pneumococcal acute otitis media following the introduction of pneumococcal conjugate vaccines in the US. Vaccine 2011;29(45):8042-8.

Rozenbaum MH, Mangen MJ, Huijts SM, van der Werf TS, Postma MJ. Incidence, direct costs and duration of hospitalization of patients hospitalized with community acquired pneumonia: A nationwide retrospective claims database analysis. Vaccine 2015;33(28):3193-9.

Sato R, Gomez Rey G, Nelson S, Pinsky B. Community-acquired pneumonia episode costs by age and risk in commercially insured US adults aged=50 years. Appl Health Econ Health Policy 2013;11(3):251-8.

Torres A, Peetermans WE, Viegi G, Blasi F. Risk factors for community-acquired pneumonia in adults in Europe: A literature review. Thorax 2013;68(11):1057-65.

GonzÃ¡lez-Castillo J, MartÃn-SÃ¡nchez FJ, Llinares P, MenÃ©ndez R, Mujal A, Navas E, et al. Guidelines for the management of community-acquired pneumonia in the elderly patient. Rev Esp Quimioter 2014;27(1):69-86.

Indonesian Ministry of Health. Basic Health Survey. Mumbai: Indonesian Ministry of Health; 2013.

Skalsky K, Yahav D, Lador A, Eliakim-Raz N, Leibovici L, Paul M. Macrolides versus quinolones for community-acquired pneumonia: Meta-analysis of randomized controlled trials. Clin Microbiol Infect 2012;19(4):370-8.

Andayani TM. Farmakoekonomi Prinsip dan Metodologi. Yogyakarta: Bursa Ilmu; 2013.

Lodise TP, Kwa A, Cosler L, Gupta R, Smith RP. Comparison of beta-lactam and macrolide combination therapy versus fluoroquinolone monotherapy in hospitalized Veterans Affairs patients with community-acquired pneumonia. Antimicrob Agents Chemother 2007;51(11):3977-82.

Querol-Ribelles JM, TenÃas JM, Querol-BorrÃ¡s JM, Labrador T, Nieto A, GonzÃ¡lez-Granda D, et al. Levofloxacin versus ceftriaxone plus clarithromycin in the treatment of adults with community-acquired pneumonia requiring hospitalization. Int J Antimicrob Agents 2005;25(1):75-83.

Vardakas KZ, Siempos II, Grammatikos A, Athanassa Z, Korbila IP, Falagas ME. Respiratory fluoroquinolones for the treatment of community-acquired pneumonia: A meta-analysis of randomized controlled trials. CMAJ 2008;179(12):1269-77.

MenÃ©ndez R, Cremades MJ, MartÃnez-MoragÃ³n E, Soler JJ, Reyes S, PerpiÃ±Ã¡ M. Duration of length of stay in pneumonia: Influence of clinical factors and hospital type. Eur Respir J 2003;22(4):643-8.

Garau J, Baquero F, PÃ©rez-Trallero E, PÃ©rez JL, MartÃn-SÃ¡nchez AM, GarcÃa-Rey C, et al. Factors impacting on length of stay and mortality of community-acquired pneumonia. Clin Microbiol Infect 2008;14:322-9.