Cost-effectiveness of gatifloxacin vs ceftriaxone with a macrolide for thetreatment of community-acquired pneumonia

Study objective: To determine the cost-effectiveness of sequential TV to or al gatifloxacin therapy vs IV ceftriaxone with or without IV erythromycin t o oral clarithromycin therapy to treat community-acquired pneumonia (CAP) p atients requiring hospitalization. Patients: Two hundred eighty-three patients enrolled in a randomized, doubl e-blind, clinical trial were eligible for inclusion in the cost-effectivene ss analysis. Methods: Data collected included patient demographics, clinical and microbi ological outcomes, length of stay (LOS), and antibiotic-related LOS (LOSAR) . Costs evaluated include drug acquisition (level 1); plus costs of prepara tion, dispensing, and administration, treating adverse events, and clinical failures (level 2); plus hospital per diem costs (level 3). Robustness of economic findings was tested using sensitivity analyses. Results: Two hundred three patients were clinically and economically evalua ble (98 receiving gatifloxacin and 105 receiving ceftriaxone). IV erythromy cin was administered to 35 patients in the ceftriaxone-treated group. Oral conversion was achieved in 98% of patients in each group. Clinical cure and microbiological eradication rates did not differ statistically (98% and 97 % with gatifloxacin vs 92% and 92% with ceftriaxone, respectively). Overall , neither geometric mean LOS nor LOSAR differed significantly (4.2 days and 4.1 days with gatifloxacin vs 4.9 days and 4.9 days with ceftriaxone, resp ectively). Treatment failures in the ceftriaxone group contributed to a mea n incremental increase in LOSAR of 1.09 days and increased mean cost per pa tient. The geometric mean costs per patient (level 3) were $5,109 for gatif loxacin and $6,164 for ceftriaxone (p = 0.011). The cost-effectiveness rati os (mean cost per expected success) were $5,236:1 and $7,047:1 for gatiflox acin and ceftriaxone, respectively. Conclusions: Gatifloxacin monotherapy for CAP patients requiring hospitaliz ation is clinically effective and provides an economic advantage compared t o the regimen of ceftriaxone with or without erythromycin IV with a switch to oral clarithromycin.