Economic evaluation of adherence to treatment guidelines in non-intensive care pneumonia

¹ Servicio de Neumología, Hospital Universitario La Fe, Valencia, Spain
² Universidad autónoma de Barcelona, Spain

^* To whom correspondence should be addressed. E-mail: rmenend{at}separ.es.

	Abstract

Guidelines have been developed to improve the treatment of community acquired pneumonia (CAP), but information regarding their influence on costs is lacking. Our objective was to conduct a cost-effectiveness analysis, from the hospital perspective, of CAP treatment when adhering to Spanish guidelines.

A prospective cohort study was performed in 271 patients with CAP, admitted to a tertiary-care hospital, not needing intensive care. Collected data included patients' characteristics, co-morbidity, initial risk class, resource use (medication, blood and microbiological analyses, and radiology) and economic data. Antimicrobial treatment was recorded as adherent or not to Spanish guidelines. Outcome measures were mortality and re-admission at 30 days.

The median cost for adherent treatment was 1665.5 versus 1710.5 euros for non-adherent treatment. Mortality and re-admission were 10% and 2.1% for adherent treatment versus 13.6% and 6.2% for non-adherent treatment. The cost-effectiveness ratio was 2,277euros /expected cure for the patients treated according to the guidelines and 2,552euros /expected cure for the non-adherence group. The incremental cost-effectiveness ratio showed that adherence to treatment guidelines saved 1,121euros /patient cured compared to non-adherence. The sensitivity analysis demonstrated that the findings were robust.

An antimicrobial treatment according to guidelines is the dominant alternative because of its cost-effectiveness.