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Cost-effectiveness of full-course oral levofloxacin in severe community-acquired pneumonia

Services of ¹ Medicine A and ² Infectious Diseases, Dept of Internal Medicine, University Hospital, Lausanne, and ³ Service of Medicine, Centre Hospitalier Yverdon-Chamblon, Yverdon, Switzerland.

CORRESPONDENCE: J-B. Wasserfallen, Service of Medicine A, University Hospital (CHUV), CH-1011, Lausanne, Switzerland. Fax: 41 213141818. E-mail: Jean-Blaise.Wasserfallen@chuv.hospvd.ch

Keywords: Community-acquired pneumonia, cost-effectiveness, economics, fluoroquinolones, oral therapy

Received: December 29, 2003
Accepted May 20, 2004

Oral levofloxacin is as efficient as sequential antibiotic treatment in community-acquired pneumonia (CAP). The current authors assessed whether oral levofloxacin treatment of patients with severe CAP, followed-up for 30 days, would save money.

Over a 12-month period, 129 hospitalised patients with severe non-intensive care unit CAP were randomly assigned to receive either oral levofloxacin or sequential antibiotic treatment. Direct and indirect costs were compared over a 30-day period from several perspectives.

CAP resolved in 71 out of 77 oral levofloxacin (92%) and in 34 out of 37 sequential antibiotic treatment patients (92%). Patients' characteristics, treatment duration, hospital length of stay and mortality were similar in both groups. Drug acquisition costs were 1.7-times smaller in oral levofloxacin patients, who were less often transferred to rehabilitation centres, but they used more physicians' visits during follow-up and their total costs were lower. As only a minority of patients was still active, inability to work and, hence, indirect costs were similar in both groups.

In this study, oral levofloxacin for severe non-intensive care unit community-acquired pneumonia was equally effective as sequential antibiotic treatment, but did not lead to major costs savings except for drug acquisition costs. External factors linked with patients' characteristics and/or medical practice are likely to play a role and should be addressed.