A simulation model of the cost of treatment failure in patients hospitalised with community-acquired pneumonia in the US

Abstract number: 1133_29

Neil N., Lamm D., Ogden K., Noe L., Peterson L., Mallick R.

Objective:  

Managing patients hospitalized with community-acquired pneumonia (CAP) in the US is costly, particularly for those failing IV antibiotic therapy. We developed a simulation model to estimate the cost of treatment failure in this population.

Methods:  

The simulation is based on American Thoracic Society (ATS) treatment guidelines, published literature and expert opinion. The model simulates initial, empiric IV therapy through as many as three subsequent courses of therapy. Patients requiring third-line therapy are assumed to either achieve cure or expire. Base-case analyses include the most common pathogens, resistance patterns and treatment regimens, and consider immune-competent Usual Care, Penicillin-allergic, and PORT Class V subpopulations. The model considers only CAP-related costs. Therapeutic decisions are simulated on the basis of ATS guidelines and prioritized to minimize the use of fluoroquinolones early in treatment, minimize drug cost and maximize drug efficacy. Resource use is estimated from the payer perspective in 2002 US dollars; component costs include diagnostics, antibiotics, monitoring, ICU and non-ICU care, respiratory support and complications. At each line of therapy, our analysis focused on the subsequent costs of only those patients who failed therapy. We varied key parameters in sensitivity analyses.

Results:  

Each patient failing initial, empiric therapy generated an average of $5,393 in additional care costs before achieving cure or expiring. Average per patient cost of failure at first- and second-line treatment was $6,028 and $6,113, respectively. Our estimates were most sensitive to assumptions about case mix, bed costs and mortality.

Conclusions:  

Our findings indicate that failing initial, empiric therapy adds $5,393 per patient to the cost of care. On average, patients requiring three lines of antibiotic therapy before achieving therapeutic success cost about $11,830 more to treat than those cured with the initial, empiric regimen.