Cost-minimization analysis of pneumonia treatment in Indonesia

Pneumonia is one of the significant causes of death in developing countries, including Indonesia. As the capital of West Java, Bandung is one of the cities with the highest pneumonia cases in this province. The objective of this study was to conduct cost -minimization analysis of pneumonia treatment in Indonesia by using one of the private hospitals in Bandung as a reference case. The use of cefuroxime and ceftizoxime was considered in adult hospitalized patients. In addition, ampicillin-sulbactam and ceftriaxone usage was compared in pediatric hospitalized patients. A cross-sectional descriptive study was applied by collecting data retrospectively from medical records of adult and pediatric patients who met the inclusion criteria at one of the private hospitals in Bandung from January 2017 to December 2018. We applied the following inclusion criteria: (i) adult (> 20 years old) and pediatric (0-5 years old) patients who were diagnosed with pneumonia; and (ii) adult patients who received cefuroxime or ceftizoxime antibiotic therapy and pediatric patients who received ampicillin-sulbactam or ceftriaxone antibiotic therapy. We excluded patients who were diagnosed with any other co-morbidities and who did not complete the treatment. The result showed that drug cost was the primary contributor to total treatment cost in adult and pediatric patients. We calculated the average total treatment cost with ceftizoxime and cefuroxime in adult patients at $149.39 and $193.05, respectively, and the average total treatment cost with ampicillin-sulbactam and ceftriaxone in pediatric patients at $202.83 and $192.77, respectively. We also estimated the LoS in a group of ceftizoxime and cefuroxime in adult patients at 3.8 and 4.1 days, respectively, and the LoS in a group of ampicillin-sulbactam and ceftriaxone in pediatric patients at 3.9 and 5.3 days, respectively. In conclusion, using ceftizoxime to treat hospitalized pneumonia in adult patients would require less cost and yield shorter LoS than cefuroxime. Using ampicillin-sulbactam to treat hospitalized pneumonia in pediatric patients would require higher costs and yield shorter LoS than ceftriaxone.