A cost-minimisation analysis comparing moxifloxacin with levofloxacin plus ceftriaxone for the treatment of patients with community-acquired pneumonia in Germany: results from the MOTIV trial.
OBJECTIVE
This study presents a cost-minimisation analysis of moxifloxacin compared to combination treatment with levofloxacin and ceftriaxone in patients hospitalised with community-acquired pneumonia (CAP) in Germany.


METHODS
In the MOTIV study, 738 adult patients with CAP requiring hospitalisation and initial parenteral antibiotic therapy were randomised to sequential IV/oral therapy with either moxifloxacin (n = 368), or levofloxacin and ceftriaxone (n = 365). The primary effectiveness endpoint was the proportion of patients demonstrating clinical improvement 5-7 days after the completion of study treatment. Subgroup analysis considered patients with severe CAP according to pneumonia severity index (PSI) risk class IV and V, microbiologically proven infection, a history of chronic obstructive pulmonary disease, and a history of cardiovascular disease. The analysis included the cost of study medication, hospital stay, readmission and inpatient procedures and diagnostics. Event frequency in the study was multiplied by German unit costs to estimate per-patient expenditure. The analysis was conducted from a hospital perspective. Sensitivity analysis investigated the effect of costing from an insurer perspective.


RESULTS
No significant difference was found in the percentage of successfully treated patients. Average per patient cost was euro 2190 for the moxifloxacin group, and euro 2619 for the levofloxacin + ceftriaxone group (difference -euro 430, 95% CI: -euro 138, -euro 740; p < 0.05). Variability in total costs was wide, with some patients accruing up to euro 18,000. Medication cost was significantly lower with moxifloxacin than levofloxacin + ceftriaxone (-euro 470, 95% CI: -euro 522, -euro 421), and accounted for between 15 and 30% of total costs.


CONCLUSIONS
In this analysis of patients hospitalised with CAP in Germany, treatment with moxifloxacin was significantly less costly than treatment with levofloxacin and ceftriaxone.
Lloyd
A
A
Fourth Hurdle Consulting Ltd, London, UK.
Holman
A
A
Evers
T
T
D000284:Administration, Oral; D001372:Aza Compounds / Q000008:administration & dosage* / Q000191:economics; D002443:Ceftriaxone / Q000008:administration & dosage* / Q000191:economics; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000191:economics / Q000382:microbiology; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D018592:Cross-Over Studies; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D024841:Fluoroquinolones; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay; D064704:Levofloxacin; D008297:Male; D000077266:Moxifloxacin; D015242:Ofloxacin / Q000008:administration & dosage* / Q000191:economics; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000191:economics* / Q000382:microbiology; D011446:Prospective Studies; D011804:Quinolines / Q000008:administration & dosage* / Q000191:economics; D012720:Severity of Illness Index; D016896:Treatment Outcome
D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D064704:Levofloxacin; D002443:Ceftriaxone; D015242:Ofloxacin; D000077266:Moxifloxacin