Pharmacoeconomic analysis of first-choice antimicrobial drugs prescribed for outpatient treatment of non-severe community-acquired pneumonia

The study aimed to perform a pharmacoeconomic analysis of antimicrobial drugs (AMDs) prescribed for the treatment of community-acquired pneumonia (CAP) in outpatient conditions.

Materials and methods. 650 medical histories of patients aged 18 to 65 years old with a diagnosis of CAP who received outpatient treatment in a larg Moscow municipal polyclinic in 2018-2019 were selected for pharmacoeconomic analysis. A model of antimicrobial drug consumption was built based on actual Algorithms of Patients’ Management endorsed by the Moscow Department of Healthcare (MDH) in 2018. The analysis of the used AMPs costs in real medical practice and the simulated situation was carried out. To process the obtained results, "Statistica 13.0" software was used

Results. The studied sampling of 650 medical histories included 386 (59.4%) women and 264 (40.6%) men with an average age of 39.8±16.8 years The average real clinical course cost of antimicrobial treatment calculated with a reference to the price and the percentage of total AMDs administered was worth 617.50 rubles. A comparison of the calculated average actual and simulated average AMDs course costs revealed that outpatient treatmen of CAP patients with adherence to the current MDH Algorithms would cost 394.13 rubles what would be 1.6 times more cost-effective than in the current practice.

Conclusions. A course of outpatient treatment of CAP with aminopenicillins and macrolides in accordance with the actual MDH Algorithms regarding the preferences of doctors when choosing antimicrobial drugs within groups would cost on average 394.13 rubles which makes it more cost-effective as compared to real practice expenses.

1. Deriushkin V.G., Ternavskii A.P., Ulyanova E.A., Gatsura S.V. The choice of antibiotic for community-acquired pneumonia - the results of a survey of doctors and an analysis of real outpatient practice. Kachestvennaya klinicheskaya praktika. 2019; (4): 50-54. (In Russ.).

2. Rachina S.A., Sinopalnikov A.I. Clinical Guidelines for Community-acquired Pneumonia in Adults: Version 2019. Prakticheshaia pulmonologia. 2018; 3: 8-12. (In Russ).

3. Chuchalin A.G. Pneumonia as an actual medical problem of the 21th century. Russian Pulmonology. 2015; 25 (2): 133-142. (In Russ). https://doi.org/10.18093/0869-0189-2015-25-2-133-142.

4. Purba A.K.R., Ascobat P., Muchtar A., et al. Cost-Effectiveness Of Culture-Based Versus Empirical Antibiotic Treatment For Hospitalized Adults With Community-Acquired Pneumonia In Indonesia: A Real-World Patient-Database Study. Clinicoecon Outcomes Res. 2019;11:729-739. Published 2019 Nov 29. https://doi.org/10.2147/CEOR.S224619.

5. Piso R.J., Arnold C., Bassetti S. Coverage of atypical pathogens for hospitalised patients with community-acquired pneumonia is not guided by clinical parameters. Swiss Med Wkly. 2013; 143: w13870. https://doi.org/10.4414/smw.2013.13870.

6. Cunha B.A. Empiric therapy of community-acquired pneumonia: guidelines for the perplexed? Chest. 2004; 125 (5): 1913-1919. https://doi.org/10.1378/chest.125.5.1913.

7. Sinopalnikov A.I. Antibiotics and community-acquired lower respiratory tract infections. To whom? Which one? Clinical microbiology and antimicrobial chemotherapy. 2019: 21 (1): 27-38. (In Russ). https://doi.org/10.36488/cmac.2019.1.27-38.

8. Community-acquired pneumonia. In the book. Patient management algorithms. Moscow Department of Health. Moscow. 2018; 58-63. (In Russ).

9. Aleksandrov M.V., Ushakova S.E., Budnikova N.V., Sevastiyanova G.I., Belevskiy A.S. Pharmacoeconomic Aspects of the Treatment of Community-acquired Pneumonia in Outpatients. Lechebnoe delo. 2016:3:29-36. (In Russ).

10. Rubio-Terres C., Cots J.M., Dommguez-Gil A., et al. Pharmacoeconomic analysis of community-acquired pneumonia treatment with telithromycin or clarithromycin. Rev Esp Quimioter. 2003; 16 (3): 295-303.

11. Jakovljevic M., Cupurdija V., Lazic Z. Cost of illness of community-acquired pneumonia. Review of the literature and possible strategies in the Serbian health care setting. Farmeconomia. Health economics and therapeutic pathways. 2013; 14 (4): 133-139.

12. The state register of maximum ex-works prices. (in Russ). [Electronic resource] URL: http://grls.rosminzdrav.ru/pricelims.aspx.

13. Order of the Ministry of health of Russia from 29.12.2012 N 1658n " About the approval of the standard of specialized medical care for moderate pneumonia" (Registered with the Ministry of justice of Russia 13.02.2013 N 27046). (in Russ). [Electronic resource] URL: https://www.rosminzdrav.ru/documents/9006-prikaz-ministerstva-zdravoohraneniya-rossiyskoy-federatsii-ot-29-dekabrya-2012-g-1658n-ob-utverzhdenii-standarta-spetsializirovannoy-meditsinskoy-pomoschi-pri-pnevmonii-sredney-stepeni-tyazhesti. Accessed: 20.04.2020.

14. Tariff agreement for the payment of medical care provided under the territorial program of compulsory medical insurance of the city of Moscow for 2019. (in Russ). [Electronic resource] URL: https://www.mgfoms.ru/system/files/prilozhenie_no_6_k_tarifnomu_soglasheniyu_na_2019_god.

15. Welte T., Torres A., Nathwani D. Clinical and economic burden of community-acquired pneumonia among adults in Europe. Thorax. 2010. https://doi.org/10.1136/thx.2009.129502.