MOXIFLOXACIN IV/PO MONOTHERAPY IS COST-EFFECTIVE TO THE GERMAN AND FRENCH HEALTHCARE SYSTEMS WHEN COMPARED TO IV/PO AMOXICILLIN/CLAVULANATE ± CLARITHROMYCIN IN THE TREATMENT OF COMMUNITY-ACQUIRED PNEUMONIA

OBJECTIVE: To conduct a cost-effectiveness analysis, from the perspectives of the German and French healthcare systems, of sequential IV/PO moxifloxacin (MXF) monotherapy versus standard comparators in hospitalized patients with community-acquired pneumonia (CAP) requiring parenteral treatment. METHODS: Costs and consequences over 21 days were evaluated based on clinical cure rates 5-7 days post-treatment and resource use reported for the intention-to-treat population of the TARGET multinational, prospective, randomized, open-label trial. This trial compared sequential IV/PO MXF (400mg OD) to IV/PO amoxicillin/clavulanate (AMC) (1.2g IV/625mg PO TID) ± clarithromycin (CLA) (500mg BID) for 7-14 days in CAP patients. Since the treatment effect on resource use (hospital length of stay [LOS]) was similar across countries, resource data from all 10 countries were pooled and valued using German and French unit prices to estimate the CAP-related cost to the German Sickness Funds and French public healthcare sector. RESULTS: Compared to AMC±CLA, treatment with MXF resulted in 5.3% more patients having clinical cure 5-7 days post-therapy (95% CI -0.1%, 12.3%), a statistically significant faster response (return to apyrexia 1 day sooner), and reduction in LOS by 0.81 days within the 21-day period. Treatment with MXF resulted in per patient savings of €266 (Germany) and €381 (France) compared to AMC±CLA, primarily due to a shorter LOS. Sensitivity analyses found these results to be robust to several costing scenarios. Using bootstrap analysis of the trial data, the probability of MXF being cost saving in both countries was estimated to be 95% or greater, while the probability of MXF being cost-effective was commensurately higher for acceptability thresholds up to €2,000 per additional patient cured. CONCLUSION: MXF shows clinical benefits and is less costly versus AMC±CLA in the treatment of CAP. Treatment with MXF is likely to result in cost savings to the German and French public healthcare systems.