Cost-effectiveness of antibiotic treatment strategies for community-acquired pneumonia: results from a cluster randomized cross-over trial

CAP START Study Group, Cornelis H. van Werkhoven, Douwe F. Postma*, Marie-Josee J. Mangen, Jan Jelrik Oosterheert, Marc J. M. Bonten

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

7 Citations (Scopus)
2 Downloads (Pure)


Background: To determine the cost-effectiveness of strategies of preferred antibiotic treatment with beta-lactam/macrolide combination or fluoroquinolone monotherapy compared to beta-lactam monotherapy.

Methods: Costs and effects were estimated using data from a cluster-randomized cross-over trial of antibiotic treatment strategies, primarily from the reduced third payer perspective (i. e. hospital admission costs). Cost-minimization analysis (CMA) and cost-effectiveness analysis (CEA) were performed using linear mixed models. CMA results were expressed as difference in costs per patient. CEA results were expressed as incremental cost-effectiveness ratios (ICER) showing additional costs per prevented death.

Results: A total of 2,283 patients were included. Crude average costs within 90 days from the reduced third payer perspective were (sic)4,294, (sic)4,392, and (sic)4,002 per patient for the beta-lactam monotherapy, beta-lactam/macrolide combination, and fluoroquinolone monotherapy strategy, respectively. CMA results were (sic)106 (95% CI (sic)-697 to (sic)754) for the beta-lactam/macrolide combination strategy and (sic)-278 (95% CI (sic)-991 to (sic) 396) for the fluoroquinolone monotherapy strategy, both compared to the beta-lactam monotherapy strategy. The ICER was not statistically significantly different between the strategies. Other perspectives yielded similar results.

Conclusions: There were no significant differences in cost-effectiveness of strategies of preferred antibiotic treatment of CAP on non-ICU wards with either beta-lactam monotherapy, beta-lactam/macrolide combination therapy, or fluoroquinolone monotherapy.

Original languageEnglish
Article number52
Pages (from-to)1-8
Number of pages8
JournalBMC Infectious Diseases
Publication statusPublished - 10-Jan-2017
Externally publishedYes


  • Beta-lactam macrolide
  • Fluoroquinolone
  • Cost-effectiveness
  • Community acquired pneumonia

Cite this