RESUMO
OBJECTIVES: A retrospective analysis was conducted to assess the cost-effectiveness of four intravenous antibiotic treatment regimens in the treatment of severe community-acquired pneumonia (CAP) in adults in a private hospital setting. The study compared some third-generation cephalosporin regimens with a second-generation cephalosporin and an amoxicillin/clavulanic acid (co-amoxiclav) regimen to investigate published South African treatment guidelines from a pharmaco-economic point of view. METHOD: A pharmaco-economic model of local costs, from a payer perspective, was based on the results of a meta-analysis of clinical papers from peer-reviewed journals. The study compared intravenous (i.v.) ceftriaxone (2 g once daily), cefotaxime (i.v. 2 g 3 times a day), cefuroxime (i.v. 750 mg 3 times a day, followed by 500 mg orally 3 times a day) and amoxicillin/clavulanic acid (1.2 g intravenously 3 times a day, followed by 625 mg orally 3 times a day) [corrected]. RESULTS: An analysis of the odds ratios (ORs) of all two-way comparisons indicated that ceftriaxone ensured significantly higher probabilities of successful outcomes than the other antibiotic treatment regimens (ORs in the order of two were indicated). The pharmaco-economic results suggested that the ceftriaxone treatment regimen was the most cost-effective in the hospital treatment of CAP in adult patients. These results proved to be robust across sensitivity analyses for success rates and treatment days. A sensitivity analysis testing the assumption that patients could be discharged once the oral treatment was initiated indicated that the amoxicillin/clavulanic acid and cefuroxime treatment arms were more cost-effective. The clinical validity of such an assumption is questionable. CONCLUSION: Despite the conservative approach followed in terms of ceftriaxone data, both the clinical results and cost-effectiveness supported the use of ceftriaxone in the treatment of CAP in adults in the hospital setting.