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.

Research design and 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 vs. $210, P = 0.001), lower pneumonia-related total costs (medical services and prescription drugs, $363 vs. $491, P < 0.001) and lower total costs ($1308 vs. $1446, P < 0.001) vs. moxifloxacin over the 30-day observation period.

Limitations:

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.

Key words::

• Community-acquired pneumonia
• Costs
• Levofloxacin
• Moxifloxacin

Transparency

Declaration of funding

This study and manuscript preparation were funded by Ortho-McNeil Janssen Scientific Affairs (OMJSA), LLC, Raritan, NJ, USA.

Declaration of financial/other relationships

J.E.S., A.G., A.S. and M.S.D. have disclosed that they are employees of Analysis Group, Inc., which has received research funding from OMJSA. M.R., S.H.M., J.S. and A.C.F. have disclosed that they are employees of OMJSA. D.N. has disclosed that he was an employee of OMJSA at the time of this research, but is currently employed by Sanofi Aventis. R.G. has disclosed that he has received an honorarium from OMJSA.

Some peer reviewers receive honoraria from CMRO for their review work. The peer reviewers of this paper have disclosed that they have no relevant financial relationships.

Acknowledgment

The authors thank Karthik Ramakrishnan, an employee of Analysis Group, for editorial assistance in the preparation of this manuscript.

This study was presented as a poster at the American Society of Health System Pharmacists 2009 Summer Meeting and Exhibition, Chicago, IL, USA on June 16, 2009; and at the 25th International Conference on Pharmacoepidemiology & Therapeutic Risk Management in Providence, RI, USA on August 16–19, 2009. This study was also presented as a podium presentation at the 49th Interscience Conference on Antimicrobial Agents and Chemotherapy, San Francisco, CA, USA on September 12–15, 2009.