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A retrospective, cost-effectiveness analysis was performed on 106 clinically evaluable patients who participated in a multi-centre, randomized study of sequential IV/oral ciprofloxacin therapy versus ceftazidime for the treatment of nosocomial pneumonia. Although nearly half of the ciprofloxacin patients received sequential therapy, the majority were treated with a full IV regimen. Clinical success rates and antibiotic-related adverse events were similar for the ciprofloxacin and ceftazidime groups. Per patient and per day costs of antibiotic acquisition; preparation and administration; treatment of adverse events, and clinical failures were compared. Decision analysis revealed that ciprofloxacin therapy was cost-effective compared to ceftazidime 2 g q8h. Varying the probability of clinical success between 60-99% failed to change the economic decision; costs for ciprofloxacin were always lower than for ceftazidime. Further sensitivity analyses demonstrated that if the ceftazidime price was reduced by 50% (equivalent to 1 g q8h), treatment costs would be similar to ciprofloxacin therapy. Increasing the ciprofloxacin price by 50% (equivalent to a q8h frequency) produced per patient costs similar to ceftazidime, although ciprofloxacin therapy retained a lower cost per day (p < 0.0002). For the treatment of nosocomial pneumonia, ciprofloxacin therapy was cost-effective compared to ceftazidime.

This study retrospectively evaluated the use of parenteral ciprofloxacin (PC) under the influence of a reserved antimicrobial drug program and an intravenous-oral stepdown program. During the first three months following its formulary introduction, 92 PC treatment courses were initiated. Fifty of these treatment courses in 49 adults were randomly selected for study. The hematology service accounted for 50% of the courses reviewed. The balance were initiated in the intensive care unit (16%), and six other services (34%). PC was used for the treatment of febrile neutropenia (50%), respiratory tract infections (20%), gram-negative sepsis (10%), and five other indications. Initial use of the intravenous formulation was considered appropriate in 92% of courses. Stepdown therapy occurred in 17 (34%) of treatment courses. Of the 26 patients considered candidates for oral therapy, seven patients (27%) were eligible for earlier stepdown and nine patients (35%) did not receive oral drug. According to our criteria, unnecessary use of the intravenous route occurred in 20% of PC treatment days. Mean total cost (acquisition plus delivery) of therapy per course was $668. This cost was higher in the hematology service (mean $990) than any other service (p = 0.0015). When stepdown therapy was employed the mean daily cost of therapy was $43.63 vs. $55.61 when the oral dosage form was not used (p = 0.04). Parenteral drug costs totalling $6245 were avoided by subsequent use of the oral dosage form. If full compliance with stepdown criteria had occurred, an estimated total savings of $10,769 could have been realized.