Abstract
BackgroundCommunity-acquired pneumonia (CAP) is a major cause of mortality and morbidity worldwide. Efficient use of resources is fundamental for best use of money among the available and novel treatment options for the management of pneumonia. The objective of this study was to systematically review the economic analysis of management strategies of pneumonia.MethodsA systematic search was performed using Academic Search Complete, MEDLINE, EconLit, Global health, MEDLINE complete and Embase databases using specific subject headings or key words in May 2018 without restricting publication year. All search results were recorded and any type of economic evaluation for management of CAP was included for detailed review. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used for quality appraisal.ResultsNineteen studies met the inclusion criteria; ten studies were trial based, five conducted analysis using model based techniques and the rest of the studies were either based on observational, record review or pre-post intervention studies. Most of the studies conducted cost-effectiveness analysis (n = 15) and compared different combinations of antimicrobials. Most were based on developed countries (n = 17), considered adult age groups (n = 16) and used a provider perspective (n = 14). Nine studies reported dominant alternatives (lower cost with higher benefit). Sensitivity analysis was performed by the majority of studies (n = 15). Fourteen studies were assessed as either being excellent, very good or good quality, with no relationship found between publication year and study quality. Methodological variation, type of microbial used, perspective, costs and outcome measures limit the compatibility among the results of the included studies.ConclusionEconomic evaluation of interventions for management of CAP to date supports cost-effectiveness of studied interventions. However, evidence relates largely to antimicrobials choice in older populations in developed countries. Parallel economic evaluation of different management strategies of CAP is recommended for both developed and developing countries to support rigorous and robust comparative economic analysis within health care systems.PROSPERO registration no: CRD42018097174
Highlights
Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality worldwide and is associated with excessive health care consumption and cost [1,2]
The 2013 Global Burden of Disease (GBD) study estimated that lower respiratory infection (LRTI) pneumonia remains the second leading contributor of global disability-adjusted life years (DALYs), and accounted for approximately 1,400 age-standardized DALYs per 100,000 population [4]
We found that Intention to treat (ITT) approach was applied by all studies, with 11 studies imputed missing data for analysis
Summary
Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality worldwide and is associated with excessive health care consumption and cost [1,2]. Despite noticeable improvement in the management of CAP, it still remains as a health burden for both developed and developing countries [3,4]. The 2013 Global Burden of Disease (GBD) study estimated that lower respiratory infection (LRTI) pneumonia remains the second leading contributor of global disability-adjusted life years (DALYs), and accounted for approximately 1,400 age-standardized DALYs per 100,000 population [4]. CAP remains as a leading cause of death for infectious diseases in the United States and Canada [3]. Community-acquired pneumonia (CAP) is a major cause of mortality and morbidity worldwide. The objective of this study was to systematically review the economic analysis of management strategies of pneumonia
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