JAC Advance Access published online on September 7, 2007
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkm313
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Costs associated with shorter duration of antibiotic therapy in hospitalized patients with mild-to-moderate–severe community-acquired pneumonia
1 Academic Medical Centre, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, PO Box 22660, 1100 DD Amsterdam, The Netherlands 2 Academic Medical Centre, Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
Received 21 May 2007; returned 15 June 2007; revised 30 July 2007; accepted 31 July 2007
* Corresponding author. Tel: +31-20-566-7002; Fax: +31-20-691-2683; E-mail: b.c.opmeer{at}amc.uva.nl
Objectives: The optimal duration of antibiotic therapy in patients with uncomplicated pneumonia may be shorter than that recommended in the current guidelines. A shorter duration will probably also lead to a cost reduction. This study evaluates the costs associated with 3 versus 8 day antibiotic therapy and subsequent follow-up in patients hospitalized with mild-to-moderate–severe community-acquired pneumonia.
Patients and methods: The economic evaluation was based on primary resource utilization data collected within the framework of a randomized, double blind, placebo-controlled trial. As 3 day therapy was shown to be clinically not inferior to 8 day therapy, the cost-minimization analysis was performed based on direct medical and indirect non-medical costs, estimated from a societal perspective for the 28 days following hospital admission.
Results: Lower costs of shorter therapy during hospital admission (
209 lower) were partially offset by higher costs for primary healthcare providers (66 higher). The average costs generated per patient by resource utilization during admission and follow-up were estimated as 3959 in the 3 day group versus 4102 in the 8 day group (difference 143 in favour of shorter therapy). The difference was affected by changes in assumptions concerning the unit costs for hospital stay but was consistently in favour of shorter therapy.
Conclusions: Shorter duration of antibiotic therapy in hospitalized patients with uncomplicated pneumonia does not result in a substantial substitution of resource utilization to primary healthcare providers. As 3 day antibiotic therapy does not lead to inferior clinical results, these findings support a 3 day therapy as a more efficient strategy.
Key Words: randomized controlled trials , economic evaluation , cost-effectiveness