Cost Effectiveness of Different Initial Antimicrobial Regimens for Elderly Community-Acquired Pneumonia Patients in General Ward

Xiudi Han; Liang Chen; Yimin Wang; Hui Li; Hong Wang; Xiqian Xing; Chunxiao Zhang; Lijun Suo; Jinxiang Wang; Guohua Yu; Guangqiang Wang; Xuexin Yao; Hongxia Yu; Lei Wang; Xuedong Liu; Bin Cao; CAP-China Network

doi:10.2147/IDR.S302852

Cost Effectiveness of Different Initial Antimicrobial Regimens for Elderly Community-Acquired Pneumonia Patients in General Ward

Infect Drug Resist. 2021 May 18:14:1845-1853. doi: 10.2147/IDR.S302852. eCollection 2021.

Authors

Xiudi Han¹, Liang Chen², Yimin Wang³, Hui Li³, Hong Wang⁴, Xiqian Xing⁵, Chunxiao Zhang⁶, Lijun Suo⁷, Jinxiang Wang⁸, Guohua Yu⁹, Guangqiang Wang¹⁰, Xuexin Yao¹¹, Hongxia Yu¹², Lei Wang¹³, Xuedong Liu¹, Bin Cao³; CAP-China Network

Affiliations

¹ Department of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital Group, Qingdao City, Shandong Province, People's Republic of China.
² Department of Infectious Disease, Beijing Jishuitan Hospital, Beijing, People's Republic of China.
³ National Clinical Research Center of Respiratory Diseases, Center for Respiratory Diseases, China-Japan Friendship Hospital, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China.
⁴ Department of Nosocomial Infection, Qingdao Municipal Hospital Group, Qingdao City, Shandong Province, People's Republic of China.
⁵ Department of Pulmonary and Critical Care Medicine, Yan'an Hospital Affiliated to Kunming Medical University, Kunming City, Yunnan Province, People's Republic of China.
⁶ Department of Pulmonary and Critical Care Medicine, Beijing Huimin Hospital, Beijing, People's Republic of China.
⁷ Department of Pulmonary and Critical Care Medicine, Zibo Municipal Hospital, Zibo City, Shandong Province, People's Republic of China.
⁸ Department of Pulmonary and Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, People's Republic of China.
⁹ Department of Pulmonary and Critical Care Medicine, Weifang No. 2 People's Hospital, Weifang City, Shandong Province, People's Republic of China.
¹⁰ Department of Respiratory Medicine, Shandong University Affiliated Qilu Hospital (Qingdao), Qingdao City, Shandong Province, People's Republic of China.
¹¹ Department of Respiratory Medicine, The 2nd Hospital of Beijing Corps, Chinese Armed Police Forces, Beijing, People's Republic of China.
¹² Department of Infectious Disease, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai City, Shandong Province, People's Republic of China.
¹³ Department of Pulmonary and Critical Care Medicine, Rizhao Chinese Medical Hospital Affiliated to Shandong Chinese Medical University, Rizhao City, Shandong Province, People's Republic of China.

Abstract

Purpose: The cost-effectiveness of different guideline-concordant antimicrobial regimens for elderly patients with community-acquired pneumonia (CAP) was rarely discussed. This study attempts to explore the most appropriate cost-effectiveness of guideline-concordant antimicrobial regimen for elderly patients with CAP in general wards.

Patients and methods: This was a multicenter, retrospective, 4:2:1 matched study enrolling 511 elderly patients with CAP hospitalized in general wards. Two hundred ninety-two patients prescribed with β-lactam monotherapy (group A), 146 patients prescribed with fluoroquinolone monotherapy (group B) and 73 patients prescribed with β-lactam/macrolide combination therapy (group C). Clinical outcomes and medical costs were analyzed by χ ² test for categorical variables or Kruskal-Wallis H-test for continuous variables.

Results: There were no statistical differences in imaging features, etiology and complications during hospitalization among these three groups. The rates of clinical failure occurrence, in-hospital mortality, 30-day mortality and 60-day mortality also had no significant differences among group A, B and C patients; however, the median length of stay (LOS) in group A patients was 12.0 days, which was significantly higher than that in group B and C patients (both 10.0 days, p<0.02). The median total, drug, and antibiotic costs for one elderly CAP episode in group B patients were RMB 10368.4, RMB 3874.8, and RMB 1796.3, respectively, which were significantly lower than those in group A and C patients (p<0.01).

Conclusion: Non-inferiority of clinical failure occurrence and short-term mortality was observed in different guideline-concordant antimicrobial regimens for elderly patients with CAP in general wards; however, the median LOS and hospitalization-associated costs for one elderly CAP episode with fluoroquinolone monotherapy were significantly lowest, and this strategy was considered to be the most cost-effective strategy in general wards.

Keywords: antimicrobial regimen; community-acquired pneumonia; cost-effectiveness; elderly; general ward.

Grants and funding

This work was supported by the National Science Grant for Distinguished Young Scholars (grant number 81425001/H0104), the National Key Technology Support Program from Ministry of Science and Technology (grant number 2015BAI12B11) and the Beijing Science and Technology Project (grant number D151100002115004).