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

Abstract

Xiudi Han,1 Liang Chen,2 Yimin Wang,3 Hui Li,3 Hong Wang,4 Xiqian Xing,5 Chunxiao Zhang,6 Lijun Suo,7 Jinxiang Wang,8 Guohua Yu,9 Guangqiang Wang,10 Xuexin Yao,11 Hongxia Yu,12 Lei Wang,13 Xuedong Liu,1 Bin Cao3 On behalf of the CAP-China Network1Department of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital Group, Qingdao City, Shandong Province, People’s Republic of China; 2Department of Infectious Disease, Beijing Jishuitan Hospital, Beijing, People’s Republic of China; 3National 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; 4Department of Nosocomial Infection, Qingdao Municipal Hospital Group, Qingdao City, Shandong Province, People’s Republic of China; 5Department of Pulmonary and Critical Care Medicine, Yan’an Hospital Affiliated to Kunming Medical University, Kunming City, Yunnan Province, People’s Republic of China; 6Department of Pulmonary and Critical Care Medicine, Beijing Huimin Hospital, Beijing, People’s Republic of China; 7Department of Pulmonary and Critical Care Medicine, Zibo Municipal Hospital, Zibo City, Shandong Province, People’s Republic of China; 8Department of Pulmonary and Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, People’s Republic of China; 9Department of Pulmonary and Critical Care Medicine, Weifang No. 2 People’s Hospital, Weifang City, Shandong Province, People’s Republic of China; 10Department of Respiratory Medicine, Shandong University Affiliated Qilu Hospital (Qingdao), Qingdao City, Shandong Province, People’s Republic of China; 11Department of Respiratory Medicine, The 2nd Hospital of Beijing Corps, Chinese Armed Police Forces, Beijing, People’s Republic of China; 12Department of Infectious Disease, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai City, Shandong Province, People’s Republic of China; 13Department of Pulmonary and Critical Care Medicine, Rizhao Chinese Medical Hospital Affiliated to Shandong Chinese Medical University, Rizhao City, Shandong Province, People’s Republic of ChinaCorrespondence: Xuedong LiuDepartment of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital Group, Jiaozhou Road, Qingdao City, 266011, Shandong Province, People’s Republic of ChinaTel [phone]Fax [phone]Email [email protected] CaoNational 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, Yinghuayuan East Street, Chao-yang District, Beijing, 100020, People’s Republic of ChinaTel [phone]Fax [phone]Email [email protected]: 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 χ2 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: community-acquired pneumonia, cost-effectiveness, antimicrobial regimen, elderly, general ward

Keywords

• community-acquired pneumonia
• cost effectiveness
• antimicrobial regimen
• elderly
• general ward