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A Cost-Minimization Analysis Comparing Azithromycin-Based and Levofloxacin-Based Protocols for the Treatment of Patients Hospitalized With Community-Acquired Pneumonia^*

Results From the CAP-IN Trial

^* From the Center for Clinical Health Policy Research, Department of Biostatistics and Bioinformatics (Dr. Samsa), and Department of Medicine (Dr. Matchar), Duke University; and Pfizer Pharmaceuticals (Drs. Harnett and Wilson), New York, NY.

Correspondence to: Gregory P. Samsa, PhD, Center for Clinical Health Policy Research, Duke University, Wachovia Plaza, 2200 West Main St, Durham, NC 27705; e-mail: samsa001{at}mc.duke.edu

Background: A randomized trial was performed comparing azithromycin and levofloxacin for treating moderately to severely ill patients hospitalized with community-acquired pneumonia. This is a cost-minimization analysis comparing those regimens.

Methods: The cost-minimization analysis compares 81 patients receiving sequential therapy with IV azithromycin plus IV ceftriaxone followed by oral azithromycin with 82 patients receiving IV levofloxacin followed by oral levofloxacin, all with complete economic data over approximately 30 days, including information about hospitalization, study medications, home care, postdischarge utilization, and lost productivity. Units of utilization were multiplied by unit prices in order to estimate cost per patient. These total costs were compared using a two-sample t test.

Results: Direct medical costs of the azithromycin group were $2,481 less than the corresponding costs in the levofloxacin group (p = 0.03; 95% confidence interval, $238 to $4,724). Most of the cost difference ($2,300) is attributable to hospital days, with the majority of these days being spent on the general medicine wards. The precise magnitude of the cost advantage attributable to azithromycin, if any, depends on both the reduction in length of hospital stay and its associated daily cost.

Conclusions: Azithromycin was no more costly than levofloxacin, and perhaps less so. Cost is but one of many factors that should be considered by clinicians in decisions involving any individual patient.

Key Words: azithromycin • community-acquired pneumonia • cost-minimization analysis • levofloxacin • randomized controlled trial

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