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Cost-Effectiveness Of Culture-Based Versus Empirical Antibiotic Treatment For Hospitalized Adults With Community-Acquired Pneumonia In Indonesia: A Real-World Patient-Database Study

Authors Purba AKR, Ascobat P, Muchtar A, Wulandari L, Dik JW, d'Arqom A, Postma MJ

Received 25 July 2019

Accepted for publication 26 September 2019

Published 29 November 2019 Volume 2019:11 Pages 729—739


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Dean Smith

Video abstract presented by Abdul Khairul Rizki Purba.

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Abdul Khairul Rizki Purba,1–5 Purwantyastuti Ascobat,3 Armen Muchtar,3 Laksmi Wulandari,6 Jan-Willem Dik,4 Annette d’Arqom,2,7 Maarten J Postma1,2,5,8 

1Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; 2Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga-Soetomo Hospital, Surabaya, Indonesia; 3Department of Pharmacology and Therapeutics, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; 4Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; 5Department of Pharmacy, Unit of Pharmacotherapy, -Epidemiology And -Economics (PTE2), University of Groningen, Groningen, The Netherlands; 6Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga-Soetomo Hospital, Surabaya, Indonesia; 7Faculty of Science, Faculty of Medicine Ramatibodhi Hospital, Faculty of Dentistry, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; 8Department of Economics, Econometrics and Finance, University of Groningen, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands

Correspondence: Abdul Khairul Rizki Purba
Universitair Medisch Centrum Groningen, Hanzeplein 1, Groningen, RB 9700, The Netherlands
Tel +31 697 52 411

Objective: This study analyzes the cost-effectiveness of culture-based treatment (CBT) versus empirical treatment (ET) as a guide to antibiotic selection and use in hospitalized patients with community-acquired pneumonia (CAP).
Patients and methods: A model was developed from the individual patient data of adults with CAP hospitalized at an academic hospital in Indonesia between 2014 and 2017 (ICD-10 J.18x). The directed antibiotic was assessed based on microbiological culture results in terms of the impact on hospital costs and life expectancy (LE). We conducted subgroup analyses for implementing CBT and ET in adults under 60 years, elderly patients (≥ 60 years), moderate-severe CAP (PSI class III-V) cases, and ICU patients. The model was designed with a lifetime horizon and adjusted patients’ ages to the average LE of the Indonesian population with a 3% discount each for cost and LE. We applied a sensitivity analyses on 1,000 simulation cohorts to examine the economic acceptability of CBT in practice. Willingness to pay (WTP) was defined as 1 or 3 times the Indonesian GDP per capita (US$ 3,570).
Results: CBT would effectively increase the patients’ LE and be cost-saving (dominant) as well. The ET group’s hospitalization cost had the greatest influence on economic outcomes. Subgroup analyses showed that CBT’s dominance remained for Indonesian patients aged under 60 years or older, patients with moderate-severe CAP, and patients in the ICU. Acceptability rates of CBT over ET were 74.9% for 1xWTP and 82.8% for 3xWTP in the base case.
Conclusion: Both sputum and blood cultures provide advantages for cost-saving and LE gains for hospitalized patients with CAP. CBT is cost-effective in patients all ages, PSI class III or above patients, and ICU patients.

Keywords: microbiological culture, empirical treatment, life expectancy, cost-effectiveness, community-acquired pneumonia

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