Cost-effectiveness of abbreviating the duration of intravenous antibacterial therapy with oral fluoroquinolones

Comprehensive economic analyses should include outpatient as well as inpatient resources. A healthcare system that includes both inpatient and outpatient care, such as prescriptions, physician care, laboratory tests and multiple other items, has been termed an Integrated Healthcare Network (IHN). Thus, cost-effectiveness analyses from the perspective of an IHN are necessary. We report a cost-effectiveness analysis from an IHN perspective on 187 evaluable hospitalised patients with serious infections who participated in randomised clinical trials that evaluated either: (i) standard regimens of intravenous (IV) antibacterial therapy, usually followed by oral antibacterial therapy; or (ii) an abbreviated regimen of intravenous antibacterials for 2 to 4 days, followed by either oral ciprofloxacin or oral enoxacin as early switch therapy. Clinical success rates were similar for the 2 treatment groups. The median number of days of in-hospital antibacterial treatment was 11 for standard IV therapy and 10 for switch therapy. Adverse events occurred in 33% of the standard IV therapy group and in 50% of the switch therapy group. Sensitivity analysis of drug price and hospital bed cost showed that switch therapy was consistently more cost-effective than standard IV therapy. Standard IV therapy would have to be 10% more effective than switch therapy to change the economic decision. In this analysis, switch therapy was a cost-effective treatment with no demonstrated change in efficacy compared with standard IV therapy.