FASTCAP study on the management of hospitalized patients with community-acquired pneumonia: pharmacoeconomic analysis of the prospective phase

BACKGROUND The economic evaluation of guide-lines based hospital management of Community- Acquired Pneumonia (CAP) with antibiotic therapy is rarely reported in literature.
AIM OF THE STUDY To compare costs and effectiveness of 5 different antibiotic courses administered to Fine IV and V class patients with CAP, hospitalized in 31 Italian Internal Medicine (IM) Departments and enrolled in the prospective phase of the multicentre FASTCAP study after the implementation of the Italian Federation of Internal Medicine (FADOI) recommendations on the management of patients with CAP admitted to IM.
METHODS 5 main antibiotic courses, administered to 786 patients, were considered (3 monotherapies: levofloxacin, 213 patients; amoxycillin/clavulanate, 134 patients; ceftriaxone, 166 patients; 2 combination therapies: amoxycillin/clavulanate + advanced macrolide, 137 patients; ceftriaxone + advanced macrolide, 136 patients). A cost analysis and two cost/effectiveness analyses (comparing, after the 1st cycle of therapy, cost to outcome for both Fine IV and V classes and cost to avoided mortality during hospitalization for Fine V class only) were carried out adopting the hospital viewpoint. Health care cost, reported in euros 2007, included: drugs acquisition; nursing time; devices for ev administration; hospitalization in inpatient setting.
RESULTS The least and the most costly therapies are levofloxacin (3,032.19 ± 2,045.34 euros) and ceftriaxone (3,666.95 ± 2,389.46 euros) in Fine IV class and amoxycillin/clavulanate (2,989.37 ± 2,242.15 euros) and ceftriaxone + advanced macrolide (4,633.59 ± 2,491.57 euros) in Fine V class. As far as the therapeutic outcome is concerned, levofloxacin dominates comparators in Fine IV class, whereas amoxycillin/clavulanate + advanced macrolide is both the most costly (3,433.16 ± 1,725.63 euros) and the most effective option (69.6%; 95% CI: 54.3-82.3%) in Fine V class. In Fine V class ceftriaxone + advanced macrolide reports both the highest cost and the highest proportion of avoided mortality during hospitalization (95.1%; 95% CI: 83.5-99.4%). Sensitivity analysis confirmed the robustness of primary findings.
DISCUSSION Our pharmacoeconomic results are consistent with the FADOI recommendations.
CONCLUSIONS Levofloxacin outperforms other antibiotic courses among Fine IV class patients, whereas the cost/effectiveness of ceftriaxone or amoxycillin/clavulanate both + advanced macrolide depends upon per patient available budget in Fine V class.