Pharmacoeconomic Analysis of the Effectiveness of Antibiotic Therapy of Nosocomial Pneumonia

Abstract

There was performed a prospective pharmacoeconomic study of effectiveness of different variants of antibacterial therapy in 118 patients diagnosed with nosocomial pneumonia who were treated in specialized departments of General hospital to identify the most effective treatment regimens from the point of view of pharmacoeconomics. Taking into account the characteristics of the local microbiological pattern and the spectrum of sensitivity to antibiotics of the most commonly encountered microorganisms in this hospital there were selected the drugs that have high activity against these pathogens. The patients were divided into groups: the first group (n=57) included the patients with early nosocomial pneumonia including 37 patients receiving combination therapy with Levofloxacin and Ceftazidime, 20 patients with Amoxiclav monotherapy; the second group (n=61) consisted of patients with later nosocomial pneumonia; 34 patients had combined treatment with Amikacin and Cefoperazone/Sulbactam, 27 patients had Imipenem monotherapy. The evaluation and analysis of clinical effectiveness with the method "cost-effectiveness" were done. It was found out that in all compared groups there is a high effectiveness of antibacterial drugs starting from 61%. The highest integral factor of clinical efficacy was in the group of Imipenem (86.1%), then in the group of Levofloxacin and Ceftazidime (71.5%), in the group of Amikacin and Cefoperazon/Sulbactam (70%), in the group of Amoxiclav (61%). Noteworthy is that only in the group of Imipenem there was no need for additional antibacterial therapy and there was short term treatment. While analyzing the cost-effectiveness correlation, it was found out that the least cost per unit of effectiveness was the cost of treatment with the combination of Levofloxacin and Ceftazidime for patients with early nosocomial pneumonia and the cost of therapy with Amikacin and Cefoperazon/Sulbactam in patients with late nosocomial pneumonia. Despite the high cost of a single dose, there was a reduction in the cost while using Imipenem due to the decrease of the time of treatment of patients in the hospital and the intensive care unit and no expenses for additional antibacterial drugs. Imipenem can be used as monotherapy as an alternative to the standard combination therapy in severe nosocomial pneumonia, primarily in patients located in intensive care unit.