A Cost-Effectiveness Study of Sequential Therapy Using Levofloxacin Versus Cefuroxime in the Treatment of Moderate Risk Community-Acquired Pneumonia (ATS III) in Adults

  • Ma. Bella R. Siasoco
  • John Q. Wong
Keywords: community-acquired pneumonia, cost-effectiveness, sequential therapy, pharmacoeconomic, protocol-guided


Objective: This study was undertaken to investigate the clinical
effectiveness and cost-effectiveness of sequential therapy in
adults with moderate-risk community-acquired pneumonia. To our
knowledge, this is the first such study to be undertaken in a country
where healthcare was paid for out-of-pocket.
Methods: This randomized open-label intention-to-treat costeffectiveness study was taken from the society’s viewpoint comparing
patients randomized to sequential therapy of either levofloxacin alone
or cefuroxime with or without erythromycin. Generally accepted
guidelines on Good Clinical Practice were observed throughout the
study period.
Results: Protocol-guided sequential therapy using levofloxacin as
monotherapy demonstrated a total cost advantage over cefuroxime
axetil with or without erythromycin. Drug acquisition costs were also
statistically significantly lower (p < 0.05) in the levofloxacin group than
in the cefuroxime axetil group for both inpatient and outpatient use.
Conclusions: Employment of sequential therapy by the protocol
employed supplied physicians with unambiguous determinants
of response of their patients and provided clearer foundations for
discharge. While sequential therapy using either of the study treatment
regimens did not differ in efficacy at the end of treatment, study results
suggest that sequential therapy using a respiratory fluoroquinolone
for these patients may afford a shorter duration of hospital stay, less
adverse events and, ultimately, a reduction of out-of-pocket expenses
that would have gone to hospital expenses (room and board, visits by
healthcare personnel) had patients remained confined.


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