An economic evaluation of sequential IV/po moxifloxacin therapy compared to IV/po co-amoxidav with or without clarithromycin in the treatment of community-acquired pneumonia

Study objective: To evaluate costs, clinical consequences, and cost-effectiveness from a German and French health-care system perspective of sequential IV/po moxifloxacin monotherapy compared to co-amoxiclav with or without clarithromycin (AMC +/- CIA) 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 IV/po monotherapy with moxifloxacin (400 mg qd) to IV/po co-amoxiclav (1.2 g IV/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 (I 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 266euro and 381euro for Germany and France respectively, primarily due to the shorter length of hospital stay. Cost-effectiveness acceptability curves show moxifloxacin has a greater than or equal to 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 2,000euro per additional patient cured. Conclusion: IV/po monotherapy with moxifloxacin shows clinical benefits including increased speed of response and is cost-effective compared to IV/po AMC CLA in the treatment of CAP.