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Adding corticosteroids to antibiotics cut community-acquired pneumonia treatment costs

New data suggest that treating community-acquired pneumonia with corticosteroids in addition to antibiotics may lead to significant cost-savings to the health care system, particularly among those with severe disease.

To evaluate the potential financial benefit of corticosteroids as an adjunctive therapy for community-acquired pneumonia (CAP), a team of researchers used an individual patient data meta-analysis to create a decision-analytic model comparing the cost-effectiveness of treatment with corticosteroids plus antibiotics vs. placebo plus antibiotics.

In the model, the mean cost of treatment was $38,291.29 with corticosteroids plus antibiotics vs. $43,546.16 with placebo plus antibiotics. In the base-case analysis, the corticosteroid treatment strategy resulted in savings of $142,795 per death averted. In the probabilistic analysis, the corticosteroid treatment strategy, as compared with placebo plus antibiotics, had an 86.4% chance of being cost-effective at a willingness to pay of $50,000. Similarly, in cost-effectiveness acceptability curves, the corticosteroid treatment strategy, as compared with placebo plus antibiotics, was cost-effective in 87.6% to 94.3% of simulations for a willingness to pay ranging from $0 to $50,0000.

Among patients with severe CAP, corticosteroids plus antibiotics resulted in savings of $70,587 per death averted. However, the treatment strategy resulted in $483,016 additional costs for every death averted in nonsevere CAP. Furthermore, in the probabilistic analysis, the corticosteroid treatment strategy was also cost-effective in 82.6% of simulations for severe CAP but in only 29.9% of simulations for nonsevere disease.

“Even though the evidence on whether corticosteroids reduce mortality is inconclusive, the decreased hospital and ICU [length of stay] with corticosteroids seem to confer financial benefits,” the researchers concluded. “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 using this strategy for the treatment of CAP.” – by Melissa Foster

Disclosures: The authors report no relevant financial disclosures.