Zhuravleva M.V., Makarchenkov A.A., Taube A.A. 203

Clinical and economic analysis of antimicrobial therapy strategies for community-acquired pneumonia in real clinical practice

Purpose - a comparative pharmacoeconomic analysis of starting doses of antibiotic therapy for community-acquired pneumonia (CAP) to calculate budgetary funds and correct the prescription of antibacterial drugs at the level of medical institutions. The design of the study was a retrospective analysis of prescriptions from the medical records of patients in the treatment of CAP who were treated in multidisciplinary medical organizations providing inpatient care. Information from the patients’ medical records was entered into registration cards specially designed for this study. The research horizon is 2 years. Pharmacoeconomic analysis was carried out using methods: frequency analysis, disease cost analysis, cost minimization analysis, cost-effectiveness analysis. The calculations took into account direct medical and non-medical and indirect costs. Analysis of the frequency of appointments showed that one strategy prevailed - the appointment of a combination of ceftriaxone + azithromycin - 76% (n=39). At the same time, this strategy was effective in 74% of cases (n=29). This strategy is consistent with approved clinical guidelines for the treatment of lower respiratory tract infections. In second place in terms of the frequency of prescriptions is the strategy of monotherapy with ceftriaxone 9.8% (n=5), while in one case of prescription, azithromycin was added to ceftriaxone after 2 days of use, which can also be attributed to one therapy strategy and the treatment is considered effective. The effectiveness of the ceftriaxone treatment strategy showed its effectiveness in 80% (n=4). The structure of costs in the treatment of CAP by various strategies is similar and, in general, the strategies differ only in the greater cost of drugs for combined antibiotic therapy. The average cost of CAP treatment per patient was 37,740.50 rubles, including the cost of antibiotic therapy, which is al- most 12% of the total cost of treatment. The cost of treating CAP with the combination of ceftriaxone + azithromycin was 34232.79±4815 rubles, with ceftriaxone - 19922.08±72940 rubles. The dominant strategy for the treatment of community-acquired pneumonia in young patients was revealed - the combination of ceftriaxone + azithromycin, ceftriaxone monotherapy is also prescribed, which corresponds to current clinical guidelines and treatment protocols. This conclusion coincides with the results of previous studies on the frequency of use of antibacterial drugs in Russia. The administration of ceftriaxone and its combination with azithromycin also proved to be the most effective empiric therapy strategy with the fewest adverse reactions.
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