Cost-effectiveness study for the treatment of community acquired pneumonia (CAP) in hospitals: modeling the impact of antimicrobial resistance

Abstract

Introduction: Community–acquired pneumonia (CAP) is a common acute infection of the pulmonary parenchyma. CAP is one of the most frequent indications for antimicrobial treatment in both outpatient and inpatient settings and is associated with significant morbidity and mortality worldwide. The incidence of CAP in Brazil is estimated to be 5-11 per 1,000 inhabitants, being identified as the second most frequent reason for hospital admission in 2003 in Brazil. Methods: The cost-effectiveness model was developed to assess economic and clinical benefits of using moxifloxacin IV for patients requiring hospitalization for. The treatments considered in the model are sequential treatments, i.e. intravenous treatment followed by empirical treatment. Efficacy and microbial resistance (according to Causative pathogens) were used in the modeling of outcomes. Only direct costs were considered, the analysis was conduct under private payer perspective. Discount rates (costs/outcomes) were not applied due to time horizon being less than 1 year. Results: Results show that moxifloxacin IV/PO is the dominant treatment in Brazil when compared to levofloxacin IV/PO, beta-lactam IV/PO and beta-lactam with macrolide IV/PO. Cost of Treatment with moxifloxacin was BRL4930 compared to BRL5254 with levofloxacin. Regarding the improvement in outcomes, treatment with moxifloxacin result in 1.51% of deaths compared to 2.27% for the treatment with levofloxacin. Conclusions: Considering the methodological assumption the dominance over levofloxacin can be used as an economic argument in favor to moxifloxacin.