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Antibiotic expected effectiveness and cost under real life microbiology: evaluation of ertapenem and ceftriaxone in the treatment of community-acquired pneumonia for elderly patients in Spain.

Grau S, Lozano V, Valladares A, Cavanillas R, Xie Y, Nocea G - Clinicoecon Outcomes Res (2014)

Bottom Line: First-line treatment of CAP with ertapenem led to a higher proportion of successfully treated patients compared with ceftriaxone in Spain.Probabilistic sensitivity analysis showed that ertapenem can be a cost-saving strategy compared with ceftriaxone, with a 59% probability of being dominant (lower costs with additional health benefits) for both, elderly patients (>65 years) and patients with PSI >3.The treatment with ertapenem compared with ceftriaxone resulted in better clinical outcomes and lower treatment costs for two segments of the Spanish population: elderly patients and patients with severe pneumonia (PSI >3).

View Article: PubMed Central - PubMed

Affiliation: Hospital del Mar, Barcelona, Spain.

ABSTRACT

Background: Clinical efficacy of antibiotics may be affected by changes in the susceptibility of microorganisms to antimicrobial agents. The purpose of this study is to assess how these changes could affect the initial efficacy of ertapenem and ceftriaxone in the treatment of community-acquired pneumonia (CAP) in elderly patients and the potential consequences this may have in health care costs.

Methods: Initial efficacy in elderly was obtained from a combined analysis of two multicenter, randomized studies. An alternative scenario was carried out using initial efficacy data according to the pneumonia severity index (PSI). Country-specific pathogens distribution was obtained from a national epidemiological study, and microbiological susceptibilities to first- and second-line therapies were obtained from Spanish or European surveillance studies. A decision analytic model was used to compare ertapenem versus ceftriaxone for CAP inpatient treatment. Inputs of the model were the expected effectiveness previously estimated and resource use considering a Spanish national health system perspective. Outcomes include difference in proportion of successfully treated patients and difference in total costs between ertapenem and ceftriaxone. The model performed one-way and probabilistic sensitivity analyses.

Results: First-line treatment of CAP with ertapenem led to a higher proportion of successfully treated patients compared with ceftriaxone in Spain. One-way sensitivity analysis showed that length of stay was the key parameter of the model. Probabilistic sensitivity analysis showed that ertapenem can be a cost-saving strategy compared with ceftriaxone, with a 59% probability of being dominant (lower costs with additional health benefits) for both, elderly patients (>65 years) and patients with PSI >3.

Conclusion: The incorporation of the current antimicrobial susceptibility into the initial clinical efficacy has a significant impact in outcomes and costs in CAP treatment. The treatment with ertapenem compared with ceftriaxone resulted in better clinical outcomes and lower treatment costs for two segments of the Spanish population: elderly patients and patients with severe pneumonia (PSI >3).

No MeSH data available.


Related in: MedlinePlus

One-way sensitivity analysis for length of stay.Notes: (A) LOS decreases at the same rate for first- and second-line treatment. (B) LOS decreases to a greater extent for the first line treatment. (C) LOS decreases to a greater extent for the second line treatment.Abbreviation: LOS, length of hospital stay.
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f3-ceor-6-083: One-way sensitivity analysis for length of stay.Notes: (A) LOS decreases at the same rate for first- and second-line treatment. (B) LOS decreases to a greater extent for the first line treatment. (C) LOS decreases to a greater extent for the second line treatment.Abbreviation: LOS, length of hospital stay.

Mentions: In the one-way sensitivity analysis, the parameter most impacting the results was the LOS. As discussed above, the mean days of hospital stay observed for DRGs 89 and 90 decreased by 10.6% across the 2005–2011 period. The impact of this decrease, considering both equal and different rates for first- and second-line treatment, is represented in Figure 3. When LOS decreases at the same rate for first- and second-line treatment, there were no significant differences with the base-case results (Figure 3A). Nonetheless, higher savings were observed for the ertapenem-arm relative to ceftriaxone when LOS during first-line treatment decreased to a greater extent than for second-line (Figure 3B). When LOS was reduced at a higher rate for second-line, the difference in total costs between ertapenem and ceftriaxone was reduced as represented in Figure 3C.


Antibiotic expected effectiveness and cost under real life microbiology: evaluation of ertapenem and ceftriaxone in the treatment of community-acquired pneumonia for elderly patients in Spain.

Grau S, Lozano V, Valladares A, Cavanillas R, Xie Y, Nocea G - Clinicoecon Outcomes Res (2014)

One-way sensitivity analysis for length of stay.Notes: (A) LOS decreases at the same rate for first- and second-line treatment. (B) LOS decreases to a greater extent for the first line treatment. (C) LOS decreases to a greater extent for the second line treatment.Abbreviation: LOS, length of hospital stay.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3928454&req=5

f3-ceor-6-083: One-way sensitivity analysis for length of stay.Notes: (A) LOS decreases at the same rate for first- and second-line treatment. (B) LOS decreases to a greater extent for the first line treatment. (C) LOS decreases to a greater extent for the second line treatment.Abbreviation: LOS, length of hospital stay.
Mentions: In the one-way sensitivity analysis, the parameter most impacting the results was the LOS. As discussed above, the mean days of hospital stay observed for DRGs 89 and 90 decreased by 10.6% across the 2005–2011 period. The impact of this decrease, considering both equal and different rates for first- and second-line treatment, is represented in Figure 3. When LOS decreases at the same rate for first- and second-line treatment, there were no significant differences with the base-case results (Figure 3A). Nonetheless, higher savings were observed for the ertapenem-arm relative to ceftriaxone when LOS during first-line treatment decreased to a greater extent than for second-line (Figure 3B). When LOS was reduced at a higher rate for second-line, the difference in total costs between ertapenem and ceftriaxone was reduced as represented in Figure 3C.

Bottom Line: First-line treatment of CAP with ertapenem led to a higher proportion of successfully treated patients compared with ceftriaxone in Spain.Probabilistic sensitivity analysis showed that ertapenem can be a cost-saving strategy compared with ceftriaxone, with a 59% probability of being dominant (lower costs with additional health benefits) for both, elderly patients (>65 years) and patients with PSI >3.The treatment with ertapenem compared with ceftriaxone resulted in better clinical outcomes and lower treatment costs for two segments of the Spanish population: elderly patients and patients with severe pneumonia (PSI >3).

View Article: PubMed Central - PubMed

Affiliation: Hospital del Mar, Barcelona, Spain.

ABSTRACT

Background: Clinical efficacy of antibiotics may be affected by changes in the susceptibility of microorganisms to antimicrobial agents. The purpose of this study is to assess how these changes could affect the initial efficacy of ertapenem and ceftriaxone in the treatment of community-acquired pneumonia (CAP) in elderly patients and the potential consequences this may have in health care costs.

Methods: Initial efficacy in elderly was obtained from a combined analysis of two multicenter, randomized studies. An alternative scenario was carried out using initial efficacy data according to the pneumonia severity index (PSI). Country-specific pathogens distribution was obtained from a national epidemiological study, and microbiological susceptibilities to first- and second-line therapies were obtained from Spanish or European surveillance studies. A decision analytic model was used to compare ertapenem versus ceftriaxone for CAP inpatient treatment. Inputs of the model were the expected effectiveness previously estimated and resource use considering a Spanish national health system perspective. Outcomes include difference in proportion of successfully treated patients and difference in total costs between ertapenem and ceftriaxone. The model performed one-way and probabilistic sensitivity analyses.

Results: First-line treatment of CAP with ertapenem led to a higher proportion of successfully treated patients compared with ceftriaxone in Spain. One-way sensitivity analysis showed that length of stay was the key parameter of the model. Probabilistic sensitivity analysis showed that ertapenem can be a cost-saving strategy compared with ceftriaxone, with a 59% probability of being dominant (lower costs with additional health benefits) for both, elderly patients (>65 years) and patients with PSI >3.

Conclusion: The incorporation of the current antimicrobial susceptibility into the initial clinical efficacy has a significant impact in outcomes and costs in CAP treatment. The treatment with ertapenem compared with ceftriaxone resulted in better clinical outcomes and lower treatment costs for two segments of the Spanish population: elderly patients and patients with severe pneumonia (PSI >3).

No MeSH data available.


Related in: MedlinePlus