The Cost-effectiveness of Corticosteroids for the treatment of Community-Acquired Pneumonia
Publication date: Available online 15 November 2018
Author(s): Elina Eleftheria Pliakos, Nikolaos Andreatos, Giannoula S. Tansarli, Panayiotis D. Ziakas, Eleftherios Mylonakis
The use of corticosteroids as adjunct treatment for community-acquired pneumonia (CAP) is associated with potential clinical benefits and the aim of this study was to evaluate the cost-effectiveness of this approach.
We constructed a decision-analytic model comparing the use of corticosteroids+antibiotics to that of placebo+antibiotics for the treatment of CAP. Cost-effectiveness was determined by calculating deaths averted and incremental cost-effectiveness ratios (ICER). Uncertainty was addressed by plotting cost-effectiveness planes and acceptability curves for various willingness-to-pay thresholds.
In the base-case analysis, corticosteroids with antibiotics resulted in savings of $142,795 per death averted (ICER: $-142,795/death averted). In the probabilistic analysis, at a willingness-to-pay of $50,000, corticosteroids with antibiotics had a 86.4% chance of being cost-effective compared to placebo with antibiotics. In cost-effectiveness acceptability curves, the corticosteroids+antibiotics strategy was cost-effective in 87.6% to 94.3% of simulations compared to the placebo with antibiotics strategy for a willingness-to-pay ranging from $0 to $50,000. In patients with severe CAP (PSI classes IV/V) the corticosteroids+antibiotics strategy resulted in savings of $70,587 and had a 82.6% chance of being cost-effective compared to the placebo+antibiotics strategy.
The use of corticosteroids with antibiotics is a cost-effective strategy and results in considerable health care cost-savings, especially among patients with severe CAP (PSI classes IV/V).