PURPOSE: To evaluate treatment patterns/costs of oral moxifloxacin 400mg or levofloxacin 750mg for community-acquired pneumonia (CAP), acute bacterial sinusitis (ABS), or acute exacerbations of chronic bronchitis (AECB), for which both antibiotics are equally effective.
METHODS: Records of initial prescriptions of oral levofloxacin 750mg or moxifloxacin 400mg within 3 days of a diagnosis of CAP, ABS, or AECB (index) were obtained from a payer claims database from October 2001-March 2007. First-quarter 2007 average wholesale prices were $12.29 per moxifloxacin 400mg and $23.86 per levofloxacin 750mg tablet.
RESULTS: Manufacturer's recommendations for treating CAP, ABS, and AECB with moxifloxacin 400mg specify 7–14, 10, and 5 days, respectively. Mean moxifloxacin 400mg index prescriptions were: CAP 9.01±2.52 days; ABS 9.54±2.63 days; and AECB 7.91±2.48 days. Recommendations for treating CAP and ABS with levofloxacin 750mg specify 5 days for each indication. Mean levofloxacin 750mg index prescriptions were: CAP 6.79±2.64 days and ABS 6.36±2.78 days. For AECB, there's a manufacturer's recommendation for levofloxacin 500 mg (7 days) but none for levofloxacin 750mg. For AECB, mean levofloxacin 750mg index prescriptions was 5.91±2.13 days. Total estimated charges for moxifloxacin 400mg and levofloxacin 750mg, respectively, were: CAP, $110.79 and $162.07; ABS, $117.25 and $151.75; and AECB, $97.18 and $141.01. Differences between second-prescription rates for moxifloxacin 400mg and levofloxacin 750mg were <1.5% and contributed a negligible amount towards the relative total costs of therapy.
CONCLUSION: Moxifloxacin 400mg has a lower per-tablet cost and estimated average course of therapy charge, despite being prescribed for more days than levofloxacin 750mg. Potential reductions in per-patient antibiotic cost for effective therapy using moxifloxacin 400mg instead of levofloxacin 750mg were approximately: CAP $51, ABS $34, and AECB $44. These differences do not reflect other prescription-related costs, including refills and prescriptions for other antibiotics.
CLINICAL IMPLICATIONS: The relative cost of prescriptions should be considered when prescribing moxifloxacin 400mg or levofloxacin 750mg for CAP, ABS, or AECB, as both agents are effective and associated with similar overall medical costs exclusive of antibiotic cost.
DISCLOSURE: Prakash Navaratnam, Grant monies (from industry related sources) This study and its report were supported by Schering-Plough Pharmaceuticals, Kenilworth, NJ. Prakash Navaratnam is an employee of Informagenics, LLC (Worthington, OH), and Howard Friedman of Analytical Solutions, LLC (New York, NY). Both companies provide consultation with the pharmaceutical industry, and both Drs. Navaratnam and Friedman were remunerated by the study sponsor. Simone Crespi is an employee of the study sponsor.; No Product/Research Disclosure Information