Cost and clinical analysis of community-acquired pneumonia within an antimicrobial stewardship-governed academic hospital in South Africa, and its implications

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Bjang, Katlego and Kutume, Madimetje and Mongoai, Nthabiseng and Sebothoma, Boitshepo and Vagiri, Rajesh and Meyer, Hannelie and Godman, Brian and Makhele, Letlhogonolo (2026) Cost and clinical analysis of community-acquired pneumonia within an antimicrobial stewardship-governed academic hospital in South Africa, and its implications. Expert Review of Pharmacoeconomics and Outcomes Research. pp. 1-15. ISSN 1473-7167 (https://doi.org/10.1080/14737167.2026.2663891)

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Abstract

Background: Pneumonia is a common respiratory infection treated with antibiotics. Patients needing antibiotics risk poor outcomes due to antimicrobial resistance (AMR). In LMIC, inappropriate prescribing is common due to a lack of sufficient diagnostics, leading to empiric prescribing. Antimicrobial stewardship programmes can improve prescribing practices. Research design and methods: A retrospective cohort study reviewing antibiotic prescription charts from May to September 2024 at an academic hospital in South Africa. A treatment pathway model was used to evaluate patients’ clinical outcomes. Results: Severe pneumonia was observed in 59.3% of patients, compared with 40.7% with uncomplicated pneumonia, with the majority of severe cases occurring in patients aged 51–75 years (37.5%). The cost of treatment per patient was higher for severe pneumonia (R1,328.12) versus uncomplicated cases (R1,157.40), with labor costs the largest cost component (58%). Severe cases contributed 63% (R63, 749.10) of total treatment costs, while uncomplicated cases accounted for 37% (R38,195.50). The treatment pathway model analysis indicated that hospitalisation rates decreased from 85% on Review Day 3 to 58% on Review Day 7 for severe cases. Conclusion: Higher treatment costs and longer hospital stays were associated with severe pneumonia, underscoring the need for early, appropriate intervention.

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