title: Hospital visits and costs following outpatient treatment of CAP with levofloxacin or moxifloxacin.
abstract: BACKGROUND
  Hospital admissions (inpatient and emergency room) are a major source of medical costs for community-acquired pneumonia (CAP) initially treated in the outpatient setting. Current CAP treatment guidelines do not differentiate between outpatient treatment with levofloxacin and moxifloxacin.
  
  
  OBJECTIVE
  Compare health care resource use and medical costs to payers for CAP outpatients initiating treatment with levofloxacin or moxifloxacin.
  
  
  METHODS
  CAP episodes were identified in the PharMetrics database between 2Q04 and 2Q07 based on: pneumonia diagnosis, chest X-ray and treatment with levofloxacin or moxifloxacin. Subsequent 30-day risk of pneumonia-related hospital visits and 30-day health care costs to payers for levofloxacin vs. moxifloxacin treatment were estimated after adjusting for pre-treatment demographics, health care resource use and pneumonia-specific risk factors using propensity score and exact factor matching.
  
  
  RESULTS
  A total of 15,472 levofloxacin- and 6474 moxifloxacin-initiated CAP patients were identified. Among 6352 matched pairs, levofloxacin treatment was associated with a 35% reduction in the odds of pneumonia-related hospital visits (odds ratio = 0.65, P = 0.004), lower per-patient costs for pneumonia-related hospital visits (102 dollars vs. 210 dollars, P = 0.001), lower pneumonia-related total costs (medical services and prescription drugs, 363 dollars vs. 491 dollars, P < 0.001) and lower total costs (1308 dollars vs. 1446 dollars, P < 0.001) vs. moxifloxacin over the 30-day observation period.
  
  
  CONCLUSIONS
  Although observational analyses of claims data provide large sample sizes and reflect routine care, they do have several inherent limitations. Since randomization of subjects is not possible, adequate statistical techniques must be used to ensure that patient characteristics are well-balanced between treatment groups. In addition, data may be missing or miscoded.
  
  
  CONCLUSIONS
  CAP outpatients initiated with levofloxacin generated substantially lower costs to payers compared to matched patients initiated with moxifloxacin. The cost savings for patients initiated with levofloxacin were largely attributable to reduced rates of pneumonia-related hospitalization or ER visits.
authors.affiliation: Analysis Group, Inc., Huntington Avenue, Tenth Floor, Boston, MA 02199, USA. jsignorovitch@analysisgroup.com
authors.forename: James E
authors.initials: JE
authors.lastname: Signorovitch
authors.forename: Mei
authors.initials: M
authors.lastname: Sheng Duh
authors.forename: Anirban
authors.initials: A
authors.lastname: Sengupta
authors.forename: Anna
authors.initials: A
authors.lastname: Gu
authors.forename: Richard
authors.initials: R
authors.lastname: Grant
authors.forename: Monika
authors.initials: M
authors.lastname: Raut
authors.forename: Samir H
authors.initials: SH
authors.lastname: Mody
authors.forename: Jeff
authors.initials: J
authors.lastname: Schein
authors.forename: Alan C
authors.initials: AC
authors.lastname: Fisher
authors.forename: Daniel
authors.initials: D
authors.lastname: Ng
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D000890:Anti-Infective Agents / Q000191:economics / Q000627:therapeutic use; D001372:Aza Compounds / Q000191:economics* / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000191:economics / Q000628:therapy; D003365:Costs and Cost Analysis; D005260:Female; D024841:Fluoroquinolones; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D064704:Levofloxacin; D008297:Male; D008875:Middle Aged; D000077266:Moxifloxacin; D015242:Ofloxacin / Q000191:economics* / Q000627:therapeutic use; D010045:Outpatients / Q000706:statistics & numerical data; D011014:Pneumonia / Q000191:economics* / Q000628:therapy*; D011804:Quinolines / Q000191:economics* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D064704:Levofloxacin; D015242:Ofloxacin; D000077266:Moxifloxacin