Cost-Effectiveness of Antibiotics for Geriatric Pneumonia in an Indonesian Regional Hospital

Abstract

Cost-effectiveness of commonly used antibiotic regimens in geriatric inpatients with pneumonia was evaluated through a retrospective review of medical records at Pelabuhan Ratu Regional General Hospital (January–December 2021). Eligible patients were aged ≥60 years with a length of stay ≥2 days; 100 of 700 records met inclusion. Direct medical costs—antibiotics, inpatient care, and other medications—were obtained from hospital tariffs and expressed in Indonesian Rupiah (Rp). Clinical effectiveness at discharge was defined as temperature ≤37,8 °C, respiratory rate 30/min, and leukocyte count ≤10.500/µL. The most frequently used single agents were ceftriaxone (32%), levofloxacin (26%), azithromycin (14%), and cefixime (2%); common substitutions included ceftriaxone–azithromycin (9%) and levofloxacin–ceftriaxone (6%). The lowest average cost-effectiveness ratio (ACER) occurred with cefixime (Rp 581.209). In incremental analysis, levofloxacin–cefixime compared with ceftriaxone monotherapy yielded an incremental cost-effectiveness ratio (ICER) of Rp 117.786 per 1% additional effectiveness, supporting ceftriaxone as the more cost-effective option. Overall, cefixime was most economical by ACER, whereas ceftriaxone monotherapy was preferred by ICER.