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Cost Analysis of Levofloxacin IV Compared to

Other Guideline-endorsed Therapies for

Patients

Hospitalized with Community-acquired

Pneumonia

Objective:

Levofloxacin IV (LEV) has been shown to

reduce hospital length of stay (LOS) in patients

hospitalized with community-acquired

pneumonia (CAP) compared to other Infection

Diseases

Society of America/American Thoracic Society

guideline-recommended antibiotic regimens,

including moxifloxacin (MOX) and ceftriaxone(CEF) plus azithromycin (AZT) combination

therapy. This study aimed to estimate the

budgetary impact of utilizing LEV in a hospital

formulary for methods.

Methods:

The Excel-based model was designed to

be flexible, transparent, and user-friendly. The

model

was developed in accordance with the Good

Research Practices for Budget Impact Analysis

disseminated by the International Society for

Pharmacoeconomics and Outcomes Research

(ISPOR).

Model inputs included:

Annual hospital admissions for CAP.

Current proportional share of CAP antibiotic

regimens (i.e., current resource utilization of

LEV,

MOX, CEF, and AZT combination therapy, and

other antibiotic regimens). Future proportional share of CAP antibiotic

regimens (i.e., future resource utilization of LEV,

MOX, CEF, and AZT combination therapy, and

other antibiotic regimens).

CAP antibiotic drug costs.

Average LOS.

Hospital costs per day.

Model outputs included:

Estimated LOS under future resource

utilization.

Estimated annual total hospitalization costs

under current and future resource utilization.

Estimated annual total pharmacy costsunder current and future resource utilization.

Average hospitalization costs per treated

patient under current and future resource

utilization.

Absolute and percentage cost savings in

hospital budget compared to current resource

utilization.

Key assumptions included the following:

Increased use of LEV does not alter the

number of hospital admissions.

Treatment duration is the same as hospitalLOS.

A schematic of the model design is provided in

Figure 1.

FIGURE 1: Budget Impact Model Flow Diagram

Using the Model

Users were able to input hospital-

specific data and calculate budget impact for

the hospital of interest by comparing thecurrent resource utilization with the future

resource utilization.

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Base-case Analysis

Prevalence and Hospital Utilization Data

1,000 patients with CAP were

assumed to be hospitalized per year.

The current and future utilization ofeach CAP antibiotic regimen were hypothetical

numbers selected for the purpose of illustration

(Table 1).

CAP Antibiotic Costs Data

Drug costs per day (Table 2) were

based on wholesale acquisition cost.

The cost for combination therapy

was calculated as the sum of CEF and AZT costs.

Hospital LOS Data

Current average LOS for each CAP

case was calculated as 5.2 days, based on thenational

summary in the Diagnosis Related

Group of Simple Pneumonia and Pleurisy Age

>17 in the

2007 Medicare Provider Analysis and

Review (MEDPAR) records.1

Published data were observed on

shorter LOS with use of LEV compared to MOX

(5.83 vs. 6.38 days with 0.54 days or 8.48%

reduction),2 or compared to the CEF and AZT

combination therapy (4.6 vs. 5.4 days with 0.8

days or 14.81% reduction).3 The user was allowed to choose

how to apply the LOS reduction (absolute

reduction or relative reduction) due to use of

LEV compared to MOX and the combination

therapy.

The absolute LOS reduction due to

LEV was applied in this analysis (Table 3).

The method to calculate average LOS

under the future resource utilization varied with

the type of LOS reduction applied.

With absolute LOS reduction, thefuture average LOS was the current average LOS

adjusted by the days saved from increased

utilization of LEV.

With relative LOS reduction, the

future average LOS also depended on the LOS

associated with LEV.

LOS associated with LEV was

derived based on the current average LOS,

relative LOS

reduction due to LEV, and currentresource utilization, with the assumption that

LOS associated with other antibiotic regimens

was the same as the current average LOS.

Hospitalization Costs

The current total hospitalization

costs were the product of current hospital cost

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per day,current average LOS, and total number

of hospitalized CAP patients.

Current average LOS and total

number of hospitalized CAP patients were user

inputs as described previously.

Current hospitalization cost per day(2007 US dollars) was calculated as $1,327

based on the same data source for hospital LOS

(MEDPAR data1).

The current total pharmacy costs

were assumed to account for 12% of the total

hospitalization costs, derived from

MEDPAR data.1

Current utilization of LEV, MOX, and

CEF and AZT combination therapy were

normalized to calculate the total costs of CAP

antibiotic treatments.

The difference between the total

pharmacy costs and the CAP antibiotic costs

was defined as other pharmacy costs.

The future total hospitalization

costs were the sum of future pharmacy costs

and future non-pharmacy costs.

The future total pharmacy costs

were the sum of future CAP antibiotic costs and

future other pharmacy costs.

Future utilization of LEV, MOX, and

CEF and AZT combination therapy were

normalized to calculate the total costs of CAP

antibiotic treatments.

Future other pharmacy costs were

the product of future average LOS and the daily

other pharmacy costs derived under current

resource utilization.

The future non-pharmacy costs

were the product of future average LOS and the

daily

non-pharmacy costs derived under current

resource utilization (i.e., [total

currenthospitalization costs total current

pharmacy costs]/current average LOS)

Model results

By increasing LEV utilization from 30% to

60%, the overall annual hospital budget was

estimated to decrease by 3.91% or $270,143

($270 per patient).

The majority of the savings came from

shorter LOS due to use of LEV, where the

average

LOS per patient was estimated to decrease by3.87% or 0.2 days.

Savings in total pharmacy costs were a small

fraction of the savings in total hospital costs

(13% or $35,423).

Savings in total pharmacy costs included

savings from CAP antibiotic costs (8.62% or

$6,193)

and savings from other pharmacy costs (3.87%

or $29,230).

Scenarios with a greater proportion of LEV

use resulted in larger savings to the hospital

budget ($540 per patient under the utilization

of 90% LEV, 0% MOX, 0% CEF and AZT

combination therapy, and 10% other antibiotic

regimens).

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