Cost-effectiveness of 4 empiric antimicrobial regimens in patients with community-acquired pneumonia

This study compares the cost-effectiveness of the 4 most common empiric antimicrobial regimens used for the treatment of adults with community-acquired pneumonia (CAP) at a community health system during a 6-month period. Associations between initial antimicrobials and total hospital costs were determined. Cost-effectiveness ratios were determined by dividing the total hospital costs by the percent survival. A total of 415 patients met criteria for the Pneumonia Severity Index (PSI) risk class IV or V. Costs (adjusted for inflation) were as follows (median, 25th and 75th percentile): total hospital costs ($5,078 [$3,218-$8,144]), pharmacy costs ($753 [$455-$1,357]), and antibiotic costs ($139 [$82-$229]). The most favorable cost-effectiveness ratio was observed for patients who received levofloxacin monotherapy ($4,635 per life saved), followed by ceftriaxone plus a macrolide ($5,278), ceftriaxone monotherapy ($5,368), and ceftriaxone plus levofloxacin ($6,317). Among patients admitted to the medical floor for class IV or V CAP, empiric levofloxacin monotherapy was associated with greater cost-effectiveness than ceftriaxone monotherapy, ceftriaxone plus a macrolide, or ceftriaxone plus levofloxacin.