Treatment success with gatifloxacin for CAP leads to reduced hospital costs

By Mary Quirk,
icanNEWS staff

icanNEWS –- Gatifloxacin therapy in patients with community-acquired pneumonia (CAP) significantly reduced hospital costs compared with the "standard" regimen, report Linda A. Dresser, PharmD, and colleagues in the May issue of CHEST.

The researchers conducted a cost-effectiveness analysis from a hospital perspective comparing treatment regimens in CAP patients requiring hospitalization. They derived the economic data from a double-blind, randomized, CAP treatment trial of gatifloxacin versus ceftriaxone/clarithromycin. "In this analysis, the geometric mean cost per patient treated with gatifloxacin was $1,055 less than a ceftriaxone-containing regimen: $5,109 vs $6,164," the article says.

Dresser and colleagues explain that as well as providing coverage of both typical and atypical organisms, the use of fluoroquinolones offers the potential for earlier switch to oral therapy, leading to decreased length of hospital stay. They add that in the treatment of pneumonia, hospitalization is the key cost factor.

Mean duration of intravenous drug administration was similar (<4 days) in both the ceftriaxone-treated group (n=105) and the gatifloxacin-treated group (n=98). Conversion to oral therapy was achieved in 98% of patients in each group. The authors found no significant differences in geometric length of stay (4.2 days for gatifloxacin vs 4.9 for ceftriaxone) or in antibiotic-related length of stay (4.1 days for gatifloxacin vs 4.9 for ceftriaxone).

The authors examined costs at three levels: (1) level 1 includes the acquisition price of the study medication, (2) level 2 adds all costs directly related to antibiotic use and treatment of infection, and (3) level 3 includes all level 2 costs plus per diem and other hospital costs incurred during treatment.

Treatment failures occurred in two patients in the gatifloxacin group and in nine patients in the ceftriaxone group. The authors say that level 3 costs were higher in the ceftriaxone-treated group, which "was driven by four clinical failures who required readmission to the hospital and administration of further antimicrobial therapy."

The authors note that there were more patients admitted to the intensive care unit (ICU) in the ceftriaxone-treated group (n=11) than in the gatifloxacin-treated group (n=3). "When we excluded those patients treated in the ICU and repeated the economic analysis, gatifloxacin consistently remained the cost-effective alternative (P=0.049), although the overall cost difference decreased to approximately $700," they say.

Dresser and colleagues calculated a cost-effectiveness ratio (calculated by dividing the mean cost per patient by the probability of success, resulting in the mean cost per expected cure) for both regimens: $5,236:1 for gatifloxacin and $7,047:1 for ceftriaxone. They explain that this translates to a difference of $1,811 per successful outcome in favor of gatifloxacin.

"The drug-acquisition costs of fluoroquinolones may exceed those of traditional agents (beta-lactams, macrolides) used for the treatment of CAP. However, antibiotic costs are only a small percentage of the overall costs of treating CAP," the authors conclude.

Dresser LD, Niederman MS, Paladino JA. Cost-effectiveness of gatifloxacin vs ceftriaxone with a macrolide for the treatment of community-acquired pneumonia. CHEST 2001;119(5):1439-48

First published (June 6, 2001) on icanPREVENT.com. Copyright 2001, ican INC.

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