Combining Corticosteroids and Antibiotics May Be Cost-Effective in CAP

Treating severe community-acquired pneumonia (CAP) with a combination of corticosteroids and antibiotics may be a cost-effective strategy, according to a study published in CHEST.

Researchers designed a decision-analytic model comparing the cost of corticosteroids plus antibiotics with the cost of placebo plus antibiotics in individuals with CAP. The participants consisted of adult hospital patients with CAP, and corticosteroid use was studied at all levels using the Pneumonia Severity Index. Index classes of I through III were classified as nonsevere, and classes IV and V were classified as severe. Cost-effectiveness was determined by calculating avoided deaths and incremental cost-effectiveness ratios. When unsure, the researchers modeled cost-effectiveness planes and acceptability curves for a range of willingness-to-pay thresholds. Cost and outcomes were calculated for a time horizon of 2 months, and analysis was conducted from a  societal perspective.   

Corticosteroids plus antibiotics resulted in a savings of $142,795 per averted death. In the cost-effectiveness acceptability curves, the combination of corticosteroids and antibiotics was estimated to be cost-effective in 87.6% to 94.3% of simulations for a willingness-to-pay that ranged from $0 to $50,000. In participants with Pneumonia Severity Index classes IV and V, corticosteroids plus antibiotics produced a savings of $70,587 and an 82.6% chance of being cost-effective. In the probabilistic analysis, with willingness-to-pay at $50,000, the results demonstrated corticosteroids plus antibiotics had an 86.4% chance of being cost-effective.

In addition, the mean cost was $38,035.79 for the corticosteroids plus antibiotics group and $43,398.04 for the antibiotics plus placebo group when the analysis did not include adverse events. The corticosteroid strategy may prevent 1 death per 27 patients treated. This conclusion was made based on the difference in effectiveness, as measured by the probability of survival, between the 2 groups (0.9536 for the corticosteroid plus antibiotic group and 0.9168 for the placebo plus antibiotic group).

“Given the health and economic burden that CAP poses, as well as the controversy surrounding the use of corticosteroids in CAP, our analysis provides useful information for clinical decision makers on the economic efficiency of employing this strategy for the treatment of CAP,” the researchers concluded.

Reference

Pliakos EE, Andreatos N, Tansarli GS, Ziakas PD, Mylonakis E. The cost-effectiveness of corticosteroids for the treatment of community-acquired pneumonia [published online November 2018]. CHEST. doi:10.1016/j.chest.2018.11.001