Economic Evaluation of Nemonoxacin, Moxifloxacin and Levofloxacin in the Treatment of Early Community-Acquired Pneumonia with Possible Pulmonary Tuberculosis

Abstract

The Chinese community-acquired pneumonia (CAP) Diagnosis and Treatment Guideline 2020 recommends quinolone antibiotics as the initial empirical treatment options for CAP. However, patients with pulmonary tuberculosis (PTB) are often misdiagnosed with CAP because of the similarity of symptoms. Moxifloxacin and levofloxacin have inhibitory effects on mycobacterium tuberculosis as compared with nemonoxacin, resulting in delayed diagnosis of PTB. Hence, the aim of this study is to compare the cost-effectiveness of nemonoxacin, moxifloxacin and levofloxacin in the treatment of CAP and to determine the value of these treatments in the differential diagnosis of PTB. Primary efficacy data were collected from phase II-III randomized, double-blind, multi-center clinical trials comparing nemonoxacin to moxifloxacin (CTR20130195) and nemonoxacin to levofloxacin (CTR20140439) for the treatment of Chinese CAP patients. A decision tree was constructed to compare the cost-utility among three groups under the perspective of healthcare system. The threshold for willingness to pay (WTP) is 1–3 times GDP per capita ($11,174–33,521). Scenarios including efficacy and cost for CAP patients with a total of 6% undifferentiated PTB. Sensitivity and scenario analyses were performed to test the robustness of basic analysis. The costs of nemonoxacin, moxifloxacin, and levofloxacin were $903.72, $1053.59, and $1212.06 and the outcomes were 188.7, 188.8, and 188.5 quality-adjusted life days (QALD), respectively. Nemonoxacin and moxifloxacin were dominant compared with levofloxacin, and the ICER of moxifloxacin compared with nemonoxacin was $551,643, which was much greater than WTP; therefore, nemonoxacin was the most cost-effective option. Regarding patients with PTB who were misdiagnosed with CAP, taking nemonoxacin could save $290.76 and $205.51 when compared with moxifloxacin and levofloxacin and resulted in a gain of 2.83 QALDs. Our findings demonstrate that nemonoxacin is the more economical compared with moxifloxacin and levofloxacin, and non-fluoroquinolone antibiotics are cost-saving and utility-increasing compared to fluoroquinolones in the differential diagnosis of PTB, which can help healthcare system in making optimal policies and help clinicians in the medication of patients.

Safety and Efficacy of Nemonoxacin vs Levofloxacin in Patients With Community-Acquired Pneumonia: A Systematic Review and Meta-Analysis of Randomized Control Trials

“…Regarding the bundle branch blockage, only four patients from the nemonoxacin group reported it, contrary to the levofloxacin group, where no such findings were observed. It is recommended to consider the actual condition of the patient's body thoroughly so that there is an immediate adjustment of the medication regimen or stoppage of the treatment [ 26 ]. The hematologic adverse events consist of drug-related TEAE, which includes neutropenia and thrombocytopenia, and common TEAE, which includes leukopenia and skin rash.…”

Community-acquired pneumonia: antibiotic therapy approach after the COVID-19 pandemic. A review

“…Столь же эффективно у данной категории пациентов применение монотерапии рФХ (левофлоксацин 500 мг 2 раза в сутки, моксифлоксацин 400 мг 1 раз в сутки пер орально или парентерально) [19,20,50,53]. Следует отметить, что при высокой вероятности S. aureus или наличии факторов риска пенициллиноустойчивого S. pneumoniae микробиологически более активным, а также более эффективным с точки зрения фармакоэкономической модели оказываются моксифлоксацин (например, Кимокс®) [54][55][56][57]. Преимущество препарата заключается в менее высоком, чем у левофлоксацина, потенциале селекции устойчивых к рФХ пневмококков, а также в большей микробиологической активности в отношении основных, в том числе с высоким инвазивным потенциалом, возбудителей ВП -в частности, пневмококка и стафилококка [58][59][60].…”

Current Treatment Strategies Against Multidrug-Resistant Bacteria: A Review

“…Recently, the antibacterial drug Fetroja (Shionogi & Co.) got approval from FDA for the treatment of gram-negative bacteria-mediated cUTI in patients having limited treatment options due to hypersensitive history. The list of antibiotics currently in the phase of clinical development against various critical superbugs is summarized in Table 5 [67][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85].…”