Cost-effectiveness analysis of ceftriaxone-azithromycin combination and single levofloxacin as empirical antibiotics in community-acquired pneumonia inpatients at persahabatan hospital

Objective: Community-acquired pneumonia (CAP) is one of the most common infectious diseases. Its prevalence is especially concerning, as the disease severely impacts health and has a high mortality rate. Although antibiotics have been used to treat CAP, their use is often costly and inefficient. Thus, this study aimed to determine the cost-effectiveness of using ceftriaxone-azithromycin combination and single levofloxacin as empirical antibiotics to treat patients with CAP. Cost-effectiveness was analyzed by comparing the direct total medical cost to clinical effectiveness, which was indicated by the respective success rates in each treatment group. Methods: This study was conducted at Persahabatan Hospital in Jakarta and employed an observational study design, where data were obtained retrospectively from the secondary data contained in medical records for 2014-2016. A total of 100 patients were included in the analysis, with 64 patients using intravenous (iv) antibiotic ceftriaxone and oral azithromycin and 36 patients using iv single levofloxacin. Results: The median costs of antibiotics were significantly different between the ceftriaxone-azithromycin group and the levofloxacin group: Rp.130.756 and Rp.286.952, respectively. The direct total medical cost in the ceftriaxone-azithromycin group (Rp.6.494.998) was higher than that of the single levofloxacin group (Rp.5.444.242). The success rate was 95.3% in the ceftriaxone-azithromycin group and 97.2% in the levofloxacin group, but there were no significant differences between the two groups. The medians for the length of stay (LOS) and length of stay antibiotic-related (LOSAR) measures in the levofloxacin group were 6 and 5 days, which were shorter than the LOS and LOSAR medians in the ceftriaxone-azithromycin group: 7 days and 6 days, respectively. The average cost-effectiveness ratio value in the levofloxacin group was 56.011% effectiveness lower than that of the ceftriaxone-azithromycin group, which was Rp.68.153% effectiveness. Conclusions: Based on these results, it can be concluded that levofloxacin is more cost-effective than a combination of ceftriaxone-azithromycin for treating CAP.