Essay about Inpatient CAP Antibiotic Treatment

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Volume 12 • Number 8 • 2009
VA L U E I N H E A LT H

Comparative Analysis of Length of Stay,Total Costs, and
Treatment Success between Intravenous Moxifloxacin 400 mg and Levofloxacin 750 mg among Hospitalized Patients with
Community-Acquired Pneumonia vhe_576 1135..1143

Howard Friedman, PhD,1 Xue Song, PhD,2 Simone Crespi, MPH,3 Prakash Navaratnam, MPH, PhD4
1
Analytic Solutions, LLC, New York, NY, USA; 2Thomson Reuters Healthcare, Cambridge, MA, USA; 3Schering-Plough Pharmaceuticals,
Kenilworth, NJ, USA; 4Informagenics, LLC, Worthington, OH, USA

A B S T R AC T
Objective: This study aimed to evaluate the length of stay (LOS), costs, and treatment consistency among patients hospitalized with communityacquired pneumonia (CAP) initially treated with intravenous (IV) moxifloxacin 400 mg or IV levofloxacin 750 mg.
Methods: Adults with CAP receiving IV moxifloxacin or IV levofloxacin for Ն3 days were identified in the Premier Perspective comparative database. Primary outcomes were LOS and costs. Secondary outcomes included treatment consistency, which was defined as 1) no additional IV moxifloxacin or levofloxacin after Ն1 day off study drug; 2) no switch to another IV antibiotic; and 3) no addition of another IV antibiotic.
Results: A total of 7720 patients met inclusion criteria (6040 receiving moxifloxacin; 1680 receiving levofloxacin). Propensity matching created two cohorts (1300 patients each) well matched for demographic, clinical,

hospital, and payor characteristics. Before the patients were matched, mean LOS (5.87 vs. 5.46 days; P = 0.0004) and total costs per patient
($7302 vs. $6362; P < 0.0001) were significantly greater with moxifloxacin. After the patients were matched, mean LOS (5.63 vs. 5.51 days;
P = 0.462) and total costs ($6624 vs. $6473; P = 0.476) were comparable in both cohorts. Treatment consistency was higher for moxifloxacin before
(81.0% vs. 78.9%; P = 0.048) and after matching (82.8% vs. 78.0%;
P = 0.002).
Conclusions: In-hospital treatment of CAP with IV moxifloxacin 400 mg or IV levofloxacin 750 mg was associated with similar hospital LOS and costs in propensity-matched cohorts.
Keywords: community-acquired pneumonia, cost, hospital, length of stay, levofloxacin, moxifloxacin, treatment outcomes.

Introduction

including the likelihood that the patient will reliably take oral medications [6]. The IDSA/ATS guidelines recommend hospitalization or, where available and appropriate, intensive, in-home health-care services, for patients with confusion, urea, respiratory rate, blood pressure, and age Ն65 years scores Ն2. Empiric antibiotic therapy in hospitalized patients should consist of a respiratory fluoroquinolone (e.g., moxifloxacin or levofloxacin) or alternatively, a beta-lactam (e.g., cefotaxime, ceftriaxone, ampicillin, or for selected patients, ertapenem) plus macrolide regimen [6]. When patients are admitted directly to an intensive care unit (ICU), empiric therapy should consist of a beta-lactam plus either a respiratory fluoroquinolone or azithromycin.
The safety and efficacy of respiratory fluoroquinolones in hospitalized patients with CAP have been demonstrated in numerous studies [12–15]. Comparisons to beta-lactam– macrolide regimens or nonstandardized regimens suggest that fluoroquinolones lead to earlier hospital discharge, which in some studies has led to cost savings [16–18]. In the CommunityAcquired Pneumonia Recovery in the Elderly study, a prospective, randomized, double-blind trial, treatment with moxifloxacin 400 mg daily was associated with significantly faster clinical recovery than treatment with levofloxacin 500 mg daily in hospitalized elderly patients with CAP, although the clinical cure rates did not differ significantly when assessed 5 to
21 days after completion of treatment [15]. Nevertheless, a recent retrospective database analysis of hospitalized patients with CAP suggested that initial treatment with intravenous (IV)
levofloxacin…