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 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.