OBJECTIVES: Community Acquired Pneumonia (CAP) is a leading cause of hospitalisation and mortality in industrialised countries. This study was an economic evaluation comparing moxifloxacin with a combination of levofloxacin plus ceftriaxone in patients hospitalised with CAP in Germany. METHODS: The MOTIV trial was a multinational, prospective, randomized, double-blind study in adults with CAP requiring hospitalisation and parenteral antibiotic therapy. Patients were randomised to either moxifloxacin (N=368), or levofloxacin plus ceftriaxone (N=365) and received sequential treatment with intravenous followed by oral antibiotics for 7-14 days. The primary effectiveness endpoint was clinical response 5-7 days after completion of treatment. Resource use recorded included length of stay, ward type, investigations and procedures performed and dose and frequency of study drug used. Costs were calculated from a German hospital perspective, drug costs were taken from the Rote Liste and other costs from a recent publication. A stochastic sensitivity analysis was performed. RESULTS: Mean age was 65 years (range 18-101) and 58% of patients had severe CAP. The percentage of patients reporting clinical response (moxifloxacin: 80%, comparator: 84%) met criteria for clinical equivalence so a cost-minimisation analysis was performed. Mean per patient cost was €2190 (95% CI: €1954, €2463) for the moxifloxacin group, and €2619 (95% CI: €2422, €2832) for the comparator group, difference (-€430, 95% CI: -€740, -€138). Medication costs were significantly lower for moxifloxacin than comparator (-€470, 95% CI: -€522, -€421) but accounted for only 15-30% of total costs. Subgroup analysis of patients with COPD, cardiovascular disease, microbiologically proven pneumonia, or severe CAP at baseline produced consistent findings. Average cost was sensitive to price paid for study drugs and the daily cost of hospital stay. CONCLUSION: Treatment with moxifloxacin was significantly less costly than treatment with levofloxacin plus ceftriaxone, with no clinically significant difference in outcomes achieved.