The American Journal of Medicine
Volume 123, Issue 4, Supplement , Pages S39-S46 , April 2010

Health Economics of Use Fluoroquinolones to Treat Patients with Community-Acquired Pneumonia

  • Marcos I. Restrepo, MD, MSc

      Affiliations

    • Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
    • Division of Pulmonary and Critical Care Medicine, Department of Medicine, VERDICT/South Texas Veterans Health Care System, Audie L. Murphy Division, San Antonio, Texas, USA
    • Corresponding Author InformationRequests for reprints should be addressed to Marcos I. Restrepo, MD, MSc, Division of Pulmonary and Critical Care Medicine, VERDICT at South Texas Veterans Healthcare System, Audie L. Murphy Division, University of Texas Health Science Center, 7400 Merton Minter Boulevard (11C6), San Antonio, Texas 78229
  • ,
  • Christopher R. Frei, PharmD, MSc

      Affiliations

    • Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
    • Division of Pharmacotherapy, College of Pharmacy, University of Texas at Austin, Austin, Texas, USA

References 

  1. Cunha BA. Principles of antibiotic formulary selection for P&T committees (Part 5: the cost of antimicrobial therapy). Pharm Ther. 2003;28:662–665
  2. Hoffman JM, Shah ND, Hunkler RF, Hontz KM, Vermeulen LC. Projecting future drug expenditures—2004. Am J Health Syst Pharm. 2004;61:145–158
  3. Hoffman JM, Shah ND, Vermeulen LC, et al. Projecting future drug expenditures—2007. Am J Health Syst Pharm. 2007;64:298–314
  4. Niederman MS, McCombs JS, Unger AN, Kumar A, Popovian R. The cost of treating community-acquired pneumonia. Clin Ther. 1998;20:820–837
  5. Nicolau DP. The challenge of prescribing treatment for respiratory tract infections. Am J Manag Care. 2000;69(suppl):S419–S426
  6. Dresser LD, Niederman MS, Paladino JA. Cost-effectiveness of gatifloxacin vs ceftriaxone with a macrolide for the treatment of community-acquired pneumonia. Chest. 2001;119:1439–1448
  7. Orrick JJ, Segal R, Johns TE, Russell W, Wang F, Yin DD. Resource use and cost of care for patients hospitalised with community acquired pneumonia: impact of adherence to Infectious Diseases Society of America guidelines. Pharmacoeconomics. 2004;22:751–757
  8. Frei CR, Burgess DS. Cost-effectiveness of 4 empiric antimicrobial regimens in patients with community-acquired pneumonia. Formulary. 2005;40:298–303
  9. Sun HK, Nicolau DP, Kuti JL. Resource utilization of adults admitted to a large urban hospital with community-acquired pneumonia caused by Streptococcus pneumoniae. Chest. 2006;130:807–814
  10. Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group. The nation's health dollar, calendar year 2007: where it went [pie chart]. [CMS Website.] http://www.cms.hhs.gov/NationalHealthExpendData/downloads/PieChartSourcesExpenditures2007.pdfAccessed April 17, 2009
  11. DeFrances CJ, Lucas CA, Buie VC, Golosinskiy A. 2006 national hospital discharge survey. Natl Health Stat Report. 2008;1–20
  12. Kung HC, Hoyert DL, Xu J, Murphy SL. Deaths: final data for 2005. Natl Vital Stat Rep. 2008;56:1–120
  13. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44(suppl):S27–S72
  14. Menendez R, Torres A, Zalacain R, et al. Guidelines for the treatment of community-acquired pneumonia: predictors of adherence and outcome. Am J Respir Crit Care Med. 2005;172:757–762
  15. Marrie TJ, Lau CY, Wheeler SL, Wong CJ, Vandervoort MK, Feagan BG CAPITAL Study Investigators. A controlled trial of a critical pathway for treatment of community-acquired pneumonia. JAMA. 2000;283:749–755
  16. Menendez R, Ferrando D, Valles JM, Vallterra J. Influence of deviation from guidelines on the outcome of community-acquired pneumonia. Chest. 2002;122:612–617
  17. Fine MJ, Stone RA, Lave JR, et al. Implementation of an evidence-based guideline to reduce duration of intravenous antibiotic therapy and length of stay for patients hospitalized with community-acquired pneumonia: a randomized controlled trial. Am J Med. 2003;115:343–351
  18. Capelastegui A, Espana PP, Quintana JM, et al. Improvement of process-of-care and outcomes after implementing a guideline for the management of community-acquired pneumonia: a controlled before-and-after design study. Clin Infect Dis. 2004;39:955–963
  19. Mortensen EM, Restrepo M, Anzueto A, Pugh J. Effects of guideline-concordant antimicrobial therapy on mortality among patients with community-acquired pneumonia. Am J Med. 2004;117:726–731
  20. Marrie TJ, Wu L. Factors influencing in-hospital mortality in community-acquired pneumonia: a prospective study of patients not initially admitted to the ICU. Chest. 2005;127:1260–1270
  21. Frei CR, Restrepo MI, Mortensen EM, Burgess DS. Impact of guideline-concordant empiric antibiotic therapy in community-acquired pneumonia. Am J Med. 2006;119:865–871
  22. Reyes Calzada S, Martinez Tomas R, Cremades Romero MJ, Martinez Moragón E, Soler Cataluña JJ, Menéndez Villanueva R. Empiric treatment in hospitalized community-acquired pneumonia: impact on mortality, length of stay and re-admission. Respir Med. 2007;101:1909–1915
  23. Frei CR, Koeller JM, Burgess DS, Talbert RL, Johnsrud MT. Impact of atypical coverage for patients with community-acquired pneumonia managed on the medical ward: results from the United States Community-Acquired Pneumonia Project. Pharmacotherapy. 2003;23:1167–1174
  24. Lodise TP, Kwa A, Cosler L, Gupta R, Smith RP. Comparison of β-lactam and macrolide combination therapy versus fluoroquinolone monotherapy in hospitalized Veterans Affairs patients with community-acquired pneumonia. Antimicrob Agents Chemother. 2007;51:3977–3982
  25. Schein J, Janagap-Benson C, Grant R, Sikirica V, Doshi D, Olson W. A comparison of levofloxacin and moxifloxacin use in hospitalized community-acquired pneumonia (CAP) patients in the US: focus on length of stay. Curr Med Res Opin. 2008;24:895–906
  26. Menendez R, Reyes S, Martinez R, de la Cuadra P, Manuel Valles J, Vallterra J. Economic evaluation of adherence to treatment guidelines in nonintensive care pneumonia. Eur Respir J. 2007;29:751–756
  27. Vardakas KM, Siempos IM, Grammatikos AM, Athanassa Z, Korbilia IP, Falagas MF. Respiratory fluoroquinolones for the treatment of community-acquired pneumonia: a meta-analysis of randomized controlled trials. CMAJ. 2008;179:1269–1277
  28. Arnold FW, Lajoie AS, Brock GN, et al. Improving outcomes in elderly patients with community-acquired pneumonia by adhering to national guidelines: Community-Acquired Pneumonia Organization International cohort study results. Arch Intern Med. 2009;169:1515–1524
  29. Frei CR, Jaso TC, Mortensen EM, et al. Medical resource utilization among community-acquired pneumonia patients initially treated with levofloxacin 750 mg daily versus ceftriaxone 1000 mg plus azithromycin 500 mg daily: a US-based study. Curr Med Res Opin. 2009;25:859–868
  30. DeFrances CJ, Cullen KA, Kozak LJ. National Hospital Discharge Survey: 2005 annual summary with detailed diagnosis and procedure data. Vital Health Stat 13. 2007;1–209
  31. Colice GL, Morley MA, Asche C, Birnbaum HG. Treatment costs of community-acquired pneumonia in an employed population. Chest. 2004;125:2140–2145
  32. Raut M, Schein J, Mody S, Grant R, Benson C, Olson W. Estimating the economic impact of a half-day reduction in length of hospital stay among patients with community-acquired pneumonia in the US. Curr Med Res Opin. 2009;25:2151–2157
  33. Birnbaum HG, Morley M, Greenberg PE, Cifaldi M, Colice GL. Economic burden of pneumonia in an employed population. Arch Intern Med. 2001;161:2725–2731
  34. US Census Bureau Population Division. Table 1: annual estimates of the population for the United States, Regions, States, and Puerto Rico: April 1, 2000 to July 1, 2007 (NST-EST2007-01). 2007. [US Census Bureau Website.] http://www.census.gov/popest/states/tables/NST-EST2007-01.xlsAccessed April 17, 2009
  35. Anzueto A, Niederman MS, Pearle J, et al. Community-Acquired Pneumonia Recovery in the Elderly (CAPRIE): efficacy and safety of moxifloxacin therapy versus that of levofloxacin therapy. Clin Infect Dis. 2006;42:73–81
  36. Lelekis M, Gould IM. Sequential antibiotic therapy for cost containment in the hospital setting: why not?. J Hosp Infect. 2001;48:249–257
  37. Wong-Beringer A, Nguyen KH, Razeghi J. Implementing a program for switching from i.v. to oral antimicrobial therapy. Am J Health Syst Pharm. 2001;58:1146–1149
  38. Athanassa Z, Makris G, Dimopoulos G, Falagas ME. Early switch to oral treatment in patients with moderate to severe community-acquired pneumonia: a meta-analysis. Drugs. 2008;68:2469–2481
  39. Siegel RE, Halpern NA, Almenoff PL, Lee A, Cashin R, Greene JG. A prospective randomized study of inpatient IV antibiotics for community-acquired pneumonia: the optimal duration of therapy. Chest. 1996;110:965–971
  40. Oosterheert JJ, Bonten MJ, Schneider MM, et al. Effectiveness of early switch from intravenous to oral antibiotics in severe community acquired pneumonia: multicentre randomised trial. BMJ. 2006;333:1193
  41. Omidvari K, de Boisblanc BP, Karam G, Nelson S, Haponik E, Summer W. Early transition to oral antibiotic therapy for community-acquired pneumonia: duration of therapy, clinical outcomes, and cost analysis. Respir Med. 1998;92:1032–1039
  42. Norrby SR, Petermann W, Willcox PA, Vetter N, Salewski E. A comparative study of levofloxacin and ceftriaxone in the treatment of hospitalized patients with pneumonia. Scand J Infect Dis. 1998;30:397–404
  43. Yaqub A, Khan Z. Comparison of early intravenous to oral switch amoxicillin/clavulanate with parenteral ceftriaxone in treatment of hospitalized patients with community acquired pneumonia. Pak J Med Sci. 2005;21:259–266
  44. Castro-Guardiola A, Viejo-Rodriguez AL, Soler-Simon S, et al. Efficacy and safety of oral and early-switch therapy for community-acquired pneumonia: a randomized controlled trial. Am J Med. 2001;111:367–374
  45. Kuti JL, Le TN, Nightingale CH, Nicolau DP, Quintiliani R. Pharmacoeconomics of a pharmacist-managed program for automatically converting levofloxacin route from i.v. to oral. Am J Health Syst Pharm. 2002;59:2209–2215
  46. Davis SL, Delgado G, McKinnon PS. Pharmacoeconomic considerations associated with the use of intravenous-to-oral moxifloxacin for community-acquired pneumonia. Clin Infect Dis. 2005;41(suppl 2):S136–S143
  47. Wasserfallen JB, Erard V, Cometta A, Calandra T, Lamy O. Cost-effectiveness of full-course oral levofloxacin in severe community-acquired pneumonia. Eur Respir J. 2004;24:644–648
  48. Lode H, File TM, Mandell L, Ball P, Pypstra R, Thomas M 185 Gemifloxacin Study Group. Oral gemifloxacin versus sequential therapy with intravenous ceftriaxone/oral cefuroxime with or without a macrolide in the treatment of patients hospitalized with community-acquired pneumonia: a randomized, open-label, multicenter study of clinical efficacy and tolerability. Clin Ther. 2002;24:1915–1936
  49. Ye X, Sikirica V, Schein JR, et al. Treatment failure rates and health care utilization and costs among patients with community-acquired pneumonia treated with levofloxacin or macrolides in an outpatient setting: a retrospective claims database analysis. Clin Ther. 2008;30:358–371
  50. van Zanten AR, Engelfriet PM, van Dillen K, van Veen M, Nuijten MJ, Polderman KH. Importance of nondrug costs of intravenous antibiotic therapy. Crit Care. 2003;7:R184–R190
  51. Shehab N, Patel PR, Srinivasan A, Budnitz DS. Emergency department visits for antibiotic-associated adverse events. Clin Infect Dis. 2008;47:735–743
  52. Cosgrove SE. The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin Infect Dis. 2006;42(suppl 2):S82–S89

 Statement of author disclosure: Please see the Author Disclosures section at the end of this article.

 Dr. Restrepo is supported by a Department of Veterans Affairs Veterans Integrated Service Network 17 new faculty grant and by Grant No. KL2 RR025766 from the National Institutes of Health (NIH). Dr. Frei is supported by a Loan Repayment award from the National Institute of Allergy and Infectious Diseases of the NIH; salary support from The University of Texas at Austin College of Pharmacy and research support from Astra Zeneca, Elan, and Ortho-McNeil Janssen. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

PII: S0002-9343(10)00100-2

doi: 10.1016/j.amjmed.2010.02.005

The American Journal of Medicine
Volume 123, Issue 4, Supplement , Pages S39-S46 , April 2010