Real-world cost-effectiveness of branded versus generic amoxicillin–clavulanate in hospitalized children with pneumonia

Background and aim: Pharmacoeconomic evidence evaluating the cost–effectiveness of brand and generic drugs of the amoxicillin–clavulanic acid combination in the treatment of pediatric pneumonia has not been widely reported in Vietnam. This study aims to analyze the cost-effectiveness of generic and brand-name drugs of the amoxicillin and clavulanic acid combination in the treatment of pneumonia. Methods: This retrospective observational study was conducted on pediatric inpatients with pneumonia receiving generic drugs (n = 1069) and brand-name drugs (n = 1061) of the amoxicillin–clavulanic acid combination in a specialized pediatric hospital in Vietnam, from January 2024 to December 2025. Results: Multivariate analysis, after adjusting for age, sex, comorbidity burden, baseline severity proxy, emergency admission, and referral status, showed that the generic drug group was associated with a 6% higher adjusted cost compared to the brand-name drug group (cost ratio 1.06, 95% CI: 1.01–1.11; p = 0.019); there was no statistically significant difference in treatment success between the generic and brand-name groups (adjusted OR = 0.37; 95% CI: 0.13–1.06; p = 0.065). Cost-effectiveness analysis indicated that, when using brand-name drugs as the comparison strategy, generic use was associated with higher observed direct medical costs (ΔC = 333,669 VND) and a small difference in effectiveness (ΔE = −0.007). Probabilistic sensitivity analysis showed that patients receiving generic drugs had a 59.9% probability of being associated with higher costs and lower effectiveness under the observed conditions. Conclusions: In this single-center retrospective dataset, generic use was associated with higher observed direct medical costs, while treatment outcomes did not differ significantly between the two drug groups. Due to the observational design, causal interpretation is limited. These findings suggest that the cost of medication alone may not fully reflect the direct healthcare costs of treating pneumonia in hospitalized pediatric patients.