A cost-minimization analysis comparing azithromycin-based and levofloxacin-based protocols for the treatment of patients hospitalized with community-acquired pneumonia: results from the CAP-IN trial.
BACKGROUND
A randomized trial was performed comparing azithromycin and levofloxacin for treating moderately to severely ill patients hospitalized with community-acquired pneumonia. This is a cost-minimization analysis comparing those regimens.


METHODS
The cost-minimization analysis compares 81 patients receiving sequential therapy with IV azithromycin plus IV ceftriaxone followed by oral azithromycin with 82 patients receiving IV levofloxacin followed by oral levofloxacin, all with complete economic data over approximately 30 days, including information about hospitalization, study medications, home care, postdischarge utilization, and lost productivity. Units of utilization were multiplied by unit prices in order to estimate cost per patient. These total costs were compared using a two-sample t test.


RESULTS
Direct medical costs of the azithromycin group were 2,481 US dollars less than the corresponding costs in the levofloxacin group (p = 0.03; 95% confidence interval, 238 US dollars to 4,724 US dollars). Most of the cost difference (2,300 US dollars) is attributable to hospital days, with the majority of these days being spent on the general medicine wards. The precise magnitude of the cost advantage attributable to azithromycin, if any, depends on both the reduction in length of hospital stay and its associated daily cost.


CONCLUSIONS
Azithromycin was no more costly than levofloxacin, and perhaps less so. Cost is but one of many factors that should be considered by clinicians in decisions involving any individual patient.
Samsa
Gregory P
GP
Center for Clinical Health Policy Research, Department of Biostatistics and Bioinformatics, Duke University, Durham, NC 27705, USA. samsa001@mc.duke.edu
Matchar
David B
DB
Harnett
James
J
Wilson
Jerome
J
D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D017963:Azithromycin / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D002443:Ceftriaxone / Q000191:economics / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000191:economics*; D003365:Costs and Cost Analysis; D004359:Drug Therapy, Combination; D005260:Female; D006699:Home Care Services / Q000191:economics; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D064704:Levofloxacin; D008297:Male; D015242:Ofloxacin / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000191:economics*; D014481:United States
D000900:Anti-Bacterial Agents; D064704:Levofloxacin; D002443:Ceftriaxone; D017963:Azithromycin; D015242:Ofloxacin