title: Treatment failure rates and health care utilization and costs among patients with community-acquired pneumonia treated with levofloxacin or macrolides in an outpatient setting: a retrospective claims database analysis.
abstract: BACKGROUND
  Macrolide antibiotics and fluoroquinolones are extensively used in the treatment of community-acquired pneumonia (CAP).
  
  
  OBJECTIVE
  This analysis was conducted to compare treatment failure rates and health care utilization and cost outcomes among patients with CAP treated with levo-floxacin (500 or 750 mg) or macrolides (azithromycin, clarithromycin, or erythromycin) in an outpatient setting.
  
  
  METHODS
  This was a retrospective analysis of claims data from a large US health plan. Patients were aged > or =18 years and had a primary diagnosis of CAP that was treated with oral levofloxacin or a macrolide in an outpatient setting (including physicians' offices, outpatient clinics, urgent care centers, and large ambulatory health centers). Patients were followed for 30 days after the index drug date to measure study outcomes. Multivariate regression analysis and a propensity score technique were used to compare rates of treatment failure and CAP-related health care utilization and costs. Two post hoc subgroup analyses were conducted in patients aged > or =50 and > or =65 years.
  
  
  RESULTS
  Of the 7526 patients meeting the inclusion criteria, 2968 (39.4%) were treated with levofloxacin and 4558 (60.6%) with a macrolide. Unadjusted rates of treatment failure were 21.1% and 22.7% in the levofloxacin and macrolide cohorts, respectively. After adjustment for demographic characteristics, baseline comorbidities, and severity of illness, levofloxacin recipients were significantly less likely to experience treatment failure than macrolide recipients (odds ratio [OR] = 0.84; 95% CI, 0.75-0.94, P = 0.003). The likelihood of treatment failure was significantly lower in levofloxacin recipients aged > or =50 years (OR = 0.79; 95% CI, 0.66-0.94; P = 0.007) and > or =65 years (OR = 0.65; 95% CI, 0.43-1.00; P = 0.049) compared with the corresponding subgroups of macrolide recipients. The magnitude of this difference was greatest in the subgroup aged > or =65 years, which had a 35% reduced risk of treatment failure compared with the corresponding group of macrolide-treated patients. The rate of CAP-related emergency department visits was significantly lower among patients receiving levofloxa-cin (OR = 0.68; 95% CI, 0.51-0.91; P = 0.009); there were no differences in CAP-related hospitalizations or total CAP-related health care costs between levofloxa-cin and macrolide recipients.
  
  
  CONCLUSIONS
  Multivariate-adjusted rates of treatment failure in outpatients with CAP were significantly lower in those treated with levofloxacin relative to those treated with a macrolide. The lower rates of treatment failure with levofloxacin were consistently observed across all patients and in the subgroups aged > or =50 and > or =65 years. Rates of emergency department visits were also significantly lower among levofloxacin-treated patients, whereas overall CAP-related hospitali-zations and costs did not differ significantly between the 2 treatment groups.
authors.affiliation: i3 Innovus, Eden Prairie, Minnesota, USA. Xin.Ye@i3innovus.com
authors.forename: Xin
authors.initials: X
authors.lastname: Ye
authors.forename: Vanja
authors.initials: V
authors.lastname: Sikirica
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Schein
authors.forename: Richard
authors.initials: R
authors.lastname: Grant
authors.forename: Victoria
authors.initials: V
authors.lastname: Zarotsky
authors.forename: Dilesh
authors.initials: D
authors.lastname: Doshi
authors.forename: Carmela Janagap
authors.initials: CJ
authors.lastname: Benson
authors.forename: Aylin A
authors.initials: AA
authors.lastname: Riedel
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data*; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000191:economics; D003362:Cost-Benefit Analysis; D019992:Databases as Topic; D016527:Drug Costs; D004363:Drug Utilization; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D017721:Hospital Costs; D006801:Humans; D007344:Insurance Claim Reporting; D064704:Levofloxacin; D016015:Logistic Models; D018942:Macrolides / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D008329:Managed Care Programs / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D015242:Ofloxacin / Q000191:economics / Q000627:therapeutic use*; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000191:economics; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides; D064704:Levofloxacin; D015242:Ofloxacin