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7/28/2019 Cost Analysis of Levofloxacin IV Compared to Other Guideline
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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.
7/28/2019 Cost Analysis of Levofloxacin IV Compared to Other Guideline
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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
7/28/2019 Cost Analysis of Levofloxacin IV Compared to Other Guideline
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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).
7/28/2019 Cost Analysis of Levofloxacin IV Compared to Other Guideline
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