Economic evaluation of community acquired pneumonia management strategies: A systematic review of literature

Abstract

BackgroundCommunity-acquired pneumonia (CAP) is a major cause of mortality and morbidity worldwide. Efficient use of resources is fundamental for best use of money among the available and novel treatment options for the management of pneumonia. The objective of this study was to systematically review the economic analysis of management strategies of pneumonia.MethodsA systematic search was performed using Academic Search Complete, MEDLINE, EconLit, Global health, MEDLINE complete and Embase databases using specific subject headings or key words in May 2018 without restricting publication year. All search results were recorded and any type of economic evaluation for management of CAP was included for detailed review. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used for quality appraisal.ResultsNineteen studies met the inclusion criteria; ten studies were trial based, five conducted analysis using model based techniques and the rest of the studies were either based on observational, record review or pre-post intervention studies. Most of the studies conducted cost-effectiveness analysis (n = 15) and compared different combinations of antimicrobials. Most were based on developed countries (n = 17), considered adult age groups (n = 16) and used a provider perspective (n = 14). Nine studies reported dominant alternatives (lower cost with higher benefit). Sensitivity analysis was performed by the majority of studies (n = 15). Fourteen studies were assessed as either being excellent, very good or good quality, with no relationship found between publication year and study quality. Methodological variation, type of microbial used, perspective, costs and outcome measures limit the compatibility among the results of the included studies.ConclusionEconomic evaluation of interventions for management of CAP to date supports cost-effectiveness of studied interventions. However, evidence relates largely to antimicrobials choice in older populations in developed countries. Parallel economic evaluation of different management strategies of CAP is recommended for both developed and developing countries to support rigorous and robust comparative economic analysis within health care systems.PROSPERO registration no: CRD42018097174

Cost of childhood severe pneumonia management in selected public inpatient care facilities in Bangladesh: a provider perspective

“…LoS in hospital was the most important cost predictor and the most sensitive cost parameter in our study, which is consistent with recent reviews on pneumonia management 9 10. Per-patient provider cost varied across referral cases, with no cost variation in relation to other clinical variables such as age, sex and presence of hypoxaemia.…”

“…Major strengths include the application of a micro-costing bottom-up approach using patient-level data to estimate cost per patient, informed by literature reviews 9 10. The analysis included a large sample and estimated detailed cost for each included facility covering urban and rural areas.…”

“…A review summarising economic evidence of childhood severe pneumonia revealed high inpatient care costs in LMICs (range: US$42–1818; 2022 prices) with an average length of stay (LoS) of 5.8 days 9. Reviews highlighted the limited economic evidence and methodological limitations of LMIC studies, with particular lack of detailed costing methods using patient-specific data for resource-constrained settings 9 10…”

Cost-Effectiveness Analyses of Digital Health Technology for Improving the Uptake of Vaccination Programs: Systematic Review

“…The CHEERS checklist contains a total of 28 items on six categories: (1) title, (2) abstract, (3) methods, (4) results, (5) discussion, and (6) other relevant information. The following grading method, used for the quality assessment in the previous systematic reviews [ 21 , 22 ], was adopted in the present assessment: 1 point was granted to each CHEERS item when the item-specific requirements were fully complete, 0.5 point for partially satisfied, and 0 point for not satisfied. Each included study was then categorized into 1 of 4 completeness categories: excellent (scored ≥85%), very good (scored between 70% and 84%), good (scored between 55% and 69%), and insufficient (scored <55%) [ 21 , 23 ].…”

Association of Socio-Demographic and Climatic Factors with the Duration of Hospital Stay of Under-Five Children with Severe Pneumonia in Urban Bangladesh: An Observational Study

“…A study in rural Bangladesh has reported a positive association between the temperature and humidity and the length of stay (LoS) of children hospitalized for severe pneumonia [14]. The duration of the hospital stay is usually indicative of the severity of disease [15], and its rise causes a significant economic burden in both developed and developing countries [16]. The peak of daily temperature, humidity, and rainfall increases the risk of childhood pneumonia [2,10].…”