Model to evaluate the cost-effectiveness of different antibiotics in the management of acute bacterial exacerbations of chronic bronchitis in Germany

Summary

This study investigated the primary cost-drivers and determinants of the cost-effectiveness of antibacterial treatment of acute bacterial exacerbations of chronic bronchitis (ABECB) in Germany. It assessed the health care costs and consequences related to treatment initiated in the community using macrolides, fluoroquinolones, penicillins, and cephalosporins. Patients were categorised according to disease severity. Decision analysis was used to consider the clinical and economic consequences of various treatment options from first-line treatment initiated by a primary care physician in the community until success or failure after third-line treatment in hospital.

The key cost drivers were the clinical success/failure rates of first-line treatment and the cost per day of hospitalisation. Antibiotics with the cheapest purchase price are not necessarily the most cost-effective first-line treatment. In more severe ABECB, drug acquisition costs are only a small proportion of the total healthcare costs because the extra costs associated with treatment failure are much greater than the acquisition costs of the first-line antibiotics. Thus the most cost-effective first-line treatment is one which results in consistently high clinical effectiveness due to its broad spectrum of activity, low rate of bacterial resistance, and high patient compliance. Of the antibiotics considered, none was consistently found to be the most cost-effective treatment across the full range of scenarios investigated. However, the fluoroquinolones and cephalosporins were generally more cost-effective than the macrolides and penicillins.