An economic evaluation of sequential i.v./po moxifloxacin therapy compared to i.v./po co-amoxiclav with or without clarithromycin in the treatment of community-acquired pneumonia.
OBJECTIVE
To evaluate costs, clinical consequences, and cost-effectiveness from a German and French health-care system perspective of sequential i.v./po moxifloxacin monotherapy compared to co-amoxiclav with or without clarithromycin (AMC +/- CLA) in patients with community-acquired pneumonia (CAP) who required parenteral treatment.


METHODS
Costs and consequences over 21 days were evaluated based on clinical cure rates 5 to 7 days after treatment and health resource use reported for the TARGET multinational, prospective, randomized, open-label trial. This trial compared sequential i.v./po monotherapy with moxifloxacin (400 mg qd) to i.v./po co-amoxiclav (1.2 g i.v./625 mg po tid) with or without clarithromycin (500 mg bid) for 7 to 14 days in hospitalized patients with CAP. Since no country-by-treatment interaction was found in spite of some country differences for length of hospital stays, resource data (antimicrobial treatment, hospitalization, and out-of-hospital care) from all centers were pooled and valued using German and French unit prices to estimate CAP-related cost to the German Sickness Funds and French public health-care sector, respectively.


RESULTS
Compared to AMC +/- CLA, treatment with moxifloxacin resulted in 5.3% more patients achieving clinical cure 5 to 7 days after therapy (95% confidence interval [CI], 1.2 to 11.8%), increased speed of response (1 day sooner for median time to first return to apyrexia, p = 0.008), and a reduction in hospital stay by 0.81 days (95% CI, - 0.01 to 1.63) within the 21-day time frame. Treatment with moxifloxacin resulted in savings of 266 euro and 381 euro for Germany and France respectively, primarily due to the shorter length of hospital stay. Cost-effectiveness acceptability curves show moxifloxacin has a > or = 95% chance of being cost saving from French and German health-care perspectives, and higher probability of being cost-effective at acceptability thresholds up to 2,000 euro per additional patient cured.


CONCLUSIONS
i.v./po monotherapy with moxifloxacin shows clinical benefits including increased speed of response and is cost-effective compared to i.v./po AMC +/- CLA in the treatment of CAP.
Drummond
Michael F
MF
Innovus Research (UK) Ltd, High Wycombe, Bucks, UK.
Becker
Debbie L
DL
Hux
Margaret
M
Chancellor
Jeremy V M
JV
Duprat-Lomon
Isabelle
I
Kubin
Rolf
R
Sagnier
Pierre-Philippe
PP
D000284:Administration, Oral; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D001372:Aza Compounds; D017291:Clarithromycin; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D005260:Female; D024841:Fluoroquinolones; D005602:France; D005858:Germany; D006760:Hospitalization; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D000077266:Moxifloxacin; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000191:economics; D011804:Quinolines; D016032:Randomized Controlled Trials as Topic
D000890:Anti-Infective Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D019980:Amoxicillin-Potassium Clavulanate Combination; D017291:Clarithromycin; D000077266:Moxifloxacin