TY - JOUR
T1 - The Cost-Effectiveness of Corticosteroids for the Treatment of Community-Acquired Pneumonia
AU - Pliakos, Elina Eleftheria
AU - Andreatos, Nikolaos
AU - Tansarli, Giannoula S.
AU - Ziakas, Panayiotis D.
AU - Mylonakis, Eleftherios
N1 - Funding Information:
Author contributions: E. E. P. designed the study, performed the data collection and analysis, prepared tables and figures, participated in data interpretation, wrote and drafted the initial manuscript, approved the final manuscript as submitted, and had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. N. A. designed the study, participated in data collection, extraction and interpretation, wrote and drafted the manuscript, and approved the final manuscript as submitted. G. S. T. designed the study; participated in data collection, extraction, and interpretation; revised the manuscript; and approved the final manuscript as submitted. P. D. Z. designed the study, participated in data interpretation, reviewed and revised the manuscript, and approved the final manuscript as submitted. E. M. conceptualized and designed the study, interpreted the data, reviewed and revised the manuscript, and approved the final manuscript as submitted. E. E. P. and E. M. are guarantors of the article., Financial/nonfinancial disclosures: None declared., Additional information: The e-Appendixes, e-Figures, and e-Table can be found in the Supplemental Materials section of the online article., FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.
Publisher Copyright:
© 2018 American College of Chest Physicians
PY - 2019/4
Y1 - 2019/4
N2 - Background: The use of corticosteroids as adjunct treatment for community-acquired pneumonia (CAP) is associated with potential clinical benefits. The aim of this study was to evaluate the cost-effectiveness of this approach. Methods: We constructed a decision-analytic model comparing the use of corticosteroids + antibiotics with that of placebo + antibiotics for the treatment of CAP. Cost-effectiveness was determined by calculating deaths averted and incremental cost-effectiveness ratios. Uncertainty was addressed by plotting cost-effectiveness planes and acceptability curves for various willingness-to-pay thresholds. Results: In the base-case analysis, corticosteroids + antibiotics resulted in savings of $142,795 per death averted. In the probabilistic analysis, at a willingness to pay of $50,000, corticosteroids + antibiotics had a 86.4% chance of being cost-effective compared with placebo + antibiotics. In cost-effectiveness acceptability curves, the corticosteroids + antibiotics strategy was cost-effective in 87.6% to 94.3% of simulations compared with the placebo + antibiotics strategy for a willingness to pay ranging from $0 to $50,000. In patients with severe CAP (Pneumonia Severity Index classes IV/V) the corticosteroids + antibiotics strategy resulted in savings of $70,587 and had a 82.6% chance of being cost-effective compared with the placebo + antibiotics strategy. Conclusions: The use of corticosteroids + antibiotics is a cost-effective strategy and results in considerable health care cost-savings, especially among patients with severe CAP (Pneumonia Severity Index classes IV/V).
AB - Background: The use of corticosteroids as adjunct treatment for community-acquired pneumonia (CAP) is associated with potential clinical benefits. The aim of this study was to evaluate the cost-effectiveness of this approach. Methods: We constructed a decision-analytic model comparing the use of corticosteroids + antibiotics with that of placebo + antibiotics for the treatment of CAP. Cost-effectiveness was determined by calculating deaths averted and incremental cost-effectiveness ratios. Uncertainty was addressed by plotting cost-effectiveness planes and acceptability curves for various willingness-to-pay thresholds. Results: In the base-case analysis, corticosteroids + antibiotics resulted in savings of $142,795 per death averted. In the probabilistic analysis, at a willingness to pay of $50,000, corticosteroids + antibiotics had a 86.4% chance of being cost-effective compared with placebo + antibiotics. In cost-effectiveness acceptability curves, the corticosteroids + antibiotics strategy was cost-effective in 87.6% to 94.3% of simulations compared with the placebo + antibiotics strategy for a willingness to pay ranging from $0 to $50,000. In patients with severe CAP (Pneumonia Severity Index classes IV/V) the corticosteroids + antibiotics strategy resulted in savings of $70,587 and had a 82.6% chance of being cost-effective compared with the placebo + antibiotics strategy. Conclusions: The use of corticosteroids + antibiotics is a cost-effective strategy and results in considerable health care cost-savings, especially among patients with severe CAP (Pneumonia Severity Index classes IV/V).
KW - clinical decision making
KW - economics
KW - pneumonia
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U2 - 10.1016/j.chest.2018.11.001
DO - 10.1016/j.chest.2018.11.001
M3 - Article
C2 - 30448195
AN - SCOPUS:85061901561
SN - 0012-3692
VL - 155
SP - 787
EP - 794
JO - CHEST
JF - CHEST
IS - 4
ER -