***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE This study presents a cost-minimisation analysis of moxifloxacin compared to combination treatment with levofloxacin and ceftriaxone in patients hospitalised with community-acquired pneumonia ( CAP ) in Germany . RESEARCH DESIGN AND METHODS In the MOTIV study , 738 adult patients with CAP requiring hospitalisation and initial parenteral antibiotic therapy were r and omised to sequential IV/oral therapy with either moxifloxacin ( n = 368 ) , or levofloxacin and ceftriaxone ( n = 365 ) . The primary effectiveness endpoint was the proportion of patients demonstrating clinical improvement 5 - 7 days after the completion of study treatment . Subgroup analysis considered patients with severe CAP according to pneumonia severity index ( PSI ) risk class IV and V , microbiologically proven infection , a history of chronic obstructive pulmonary disease , and a history of cardiovascular disease . The analysis included the cost of study medication , hospital stay , readmission and inpatient procedures and diagnostics . Event frequency in the study was multiplied by German unit costs to estimate per-patient expenditure . The analysis was conducted from a hospital perspective . Sensitivity analysis investigated the effect of costing from an insurer perspective . RESULTS No significant difference was found in the percentage of successfully treated patients . Average per patient cost was euro 2190 for the moxifloxacin group , and euro 2619 for the levofloxacin + ceftriaxone group ( difference -euro 430 , 95 % CI : -euro 138 , -euro 740 ; p < 0.05 ) . Variability in total costs was wide , with some patients accruing up to euro 18,000 . Medication cost was significantly lower with moxifloxacin than levofloxacin + ceftriaxone ( -euro 470 , 95 % CI : -euro 522 , -euro 421 ) , and accounted for between 15 and 30 % of total costs . CONCLUSIONS In this analysis of patients hospitalised with CAP in Germany , treatment with moxifloxacin was significantly less costly than treatment with levofloxacin and ceftriaxone Current World Health Organization ( WHO ) guidelines for severe pneumonia treatment of under-5 children recommend hospital referral . However , high treatment cost is a major barrier for communities . We compared household costs for referred cases with management by lady health workers ( LHWs ) using oral antibiotics . This study was nested within a cluster r and omized trial in Haripur , Pakistan . Data on direct and indirect costs were collected through interviews and record review s in the 14 intervention and 14 control clusters . The average household cost/case for a LHW managed case was $ 1.46 compared with $ 7.60 for referred cases . When the cost of antibiotics provided by the LHW program was excluded from the estimates , the cost/case came to $ 0.25 and $ 7.51 for the community managed and referred cases , respectively , a 30-fold difference . Exp and ing severe pneumonia treatment with oral amoxicillin to community level could significantly reduce household costs and improve access to the underprivileged population , preventing many child deaths Background Knowledge of treatment cost is essential in assessing cost effectiveness in healthcare . Evidence of the potential impact of implementing available interventions against childhood illnesses in developing countries challenges us to define the costs of treating these diseases . The purpose of this study is to describe the total costs associated with treatment of pneumonia , malaria and meningitis in children less than five years in seven Kenyan hospitals . Methods Patient re source use data were obtained from largely prospect i ve evaluation of medical records and household expenditure during illness was collected from interviews with caretakers . The estimates for costs per bed day were based on published data . A sensitivity analysis was conducted using WHO-CHOICE values for costs per bed day . Results Treatment costs for 572 children ( pneumonia = 205 , malaria = 211 , meningitis = 102 and mixed diagnoses = 54 ) and household expenditure for 390 households were analysed . From the provider perspective the mean cost per admission at the national hospital was US $ 95.58 for malaria , US $ 177.14 for pneumonia and US $ 284.64 for meningitis . In the public regional or district hospitals the mean cost per child treated ranged from US $ 47.19 to US $ 81.84 for malaria and US $ 54.06 to US $ 99.26 for pneumonia . The corresponding treatment costs in the mission hospitals were between US $ 43.23 to US $ 88.18 for malaria and US $ 43.36 to US $ 142.22 for pneumonia . Meningitis was treated for US $ 189.41 at the regional hospital and US $ 201.59 at one mission hospital . The total treatment cost estimates were sensitive to changes in the source of bed day costs . The median treatment related household payments within quintiles defined by total household expenditure differed by type of facility visited . Public hospitals recovered up to 40 % of provider costs through user charges while mission facilities recovered 44 % to 100 % of costs . Conclusion Treatments cost for inpatient malaria , pneumonia and meningitis vary by facility type , with mission and tertiary referral facilities being more expensive compared to primary referral . Households of sick children contribute significantly towards provider cost through payment of user fees . These findings could be used in cost effectiveness analysis of health interventions Background : Practice guidelines suggest that all patients hospitalised with community-acquired pneumonia ( CAP ) should receive antibiotics within 4 h of admission . An audit at our hospital during 1999–2000 showed that this target was achieved in less than two thirds of patients with severe CAP . Methods : An experienced multidisciplinary steering group design ed a management pathway to improve the early delivery of appropriate antibiotics to patients with CAP . This was implemented using a multifaceted strategy . The effect of implementation was evaluated using a controlled before- and -after study design over two winter seasons ( November – April 2001–2 and 2002–3 ) . Cost-effectiveness analyses were performed from the hospital ’s perspective . Results : The proportion of patients receiving appropriate antibiotics within 4 h of admission to hospital increased from 33 % to 56 % at the intervention site , and from 32 % to 36 % at the control site ( absolute change adjusted for differences in severity of illness 17 % , p = 0.035 ) . The cost per additional patient receiving appropriate antibiotics within 4 h was £ 132 with no post-implementation evaluation , and £ 456 for a limited post-implementation evaluation . Simple modelling from the results of a large observational study suggests that the cost per death prevented could be £ 3003 with no post-implementation evaluation , or £ 16 632 with a limited post-implementation evaluation . Conclusions : The intervention markedly improved door-to-antibiotic time , albeit at considerable cost . It might still be a cost-effective strategy , however , to reduce mortality in CAP . Uncertainty about the cost effectiveness of such interventions is likely to be resolved only by a well- design ed , cluster r and omised trial Background Clinical efficacy of antibiotics may be affected by changes in the susceptibility of microorganisms to antimicrobial agents . The purpose of this study is to assess how these changes could affect the initial efficacy of ertapenem and ceftriaxone in the treatment of community-acquired pneumonia ( CAP ) in elderly patients and the potential consequences this may have in health care costs . Methods Initial efficacy in elderly was obtained from a combined analysis of two multicenter , r and omized studies . An alternative scenario was carried out using initial efficacy data according to the pneumonia severity index ( PSI ) . Country-specific pathogens distribution was obtained from a national epidemiological study , and microbiological susceptibilities to first- and second-line therapies were obtained from Spanish or European surveillance studies . A decision analytic model was used to compare ertapenem versus ceftriaxone for CAP inpatient treatment . Inputs of the model were the expected effectiveness previously estimated and re source use considering a Spanish national health system perspective . Outcomes include difference in proportion of successfully treated patients and difference in total costs between ertapenem and ceftriaxone .  The model performed one-way and probabilistic sensitivity analyses . Results First-line treatment of CAP with ertapenem led to a higher proportion of successfully treated patients compared with ceftriaxone in Spain . One-way sensitivity analysis showed that length of stay was the key parameter of the model . Probabilistic sensitivity analysis showed that ertapenem can be a cost-saving strategy compared with ceftriaxone , with a 59 % probability of being dominant ( lower costs with additional health benefits ) for both , elderly patients ( > 65 years ) and patients with PSI > 3 . Conclusion The incorporation of the current antimicrobial susceptibility into the initial clinical efficacy has a significant impact in outcomes and costs in CAP treatment . The treatment with ertapenem compared with ceftriaxone result ed in better clinical outcomes and lower treatment costs for two segments of the Spanish population : elderly patients and patients with severe pneumonia ( PSI > 3 ) Background : Pneumonia is one of the leading causes of morbidity and mortality among children in many developing countries . It is reported that 12.9 million children under 5 years of age died world-wide in 1990 and one-third of these deaths or 4.3 million annually were attributed to acute respiratory infection with pneumonia . Objectives : On this basis , a study was conducted in a district hospital to study the therapy outcomes of antibiotic regimens used in pediatric community-acquired pneumonia ( CAP ) management and to conduct a cost-effectiveness analysis ( CE ) between IV ampicillin versus combination therapy of IV ampicillin and IV gentamicin . Method : A prospect i ve , r and omized , controlled , single blind study was conducted in a pediatric ward in a 80-bed district hospital . Pediatric patients diagnosed with CAP aged 2 months to 5 years old were r and omly and equally divided into two treatment arms : ampicillin versus ampicillin plus gentamicin . The dose of IV ampicillin used in this study was 100 mg/kg/day divided every 6 h and 5 mg/kg of IV gentamicin as a single daily dose . Both clinical and economic evaluations were carried out to compare both treatment arms . Results : With the inclusion and exclusion criteria , only 40 patients diagnosed with CAP were included in the study . The results showed that the two treatment arms were significantly different ( P < 0.05 ) in terms of duration of patients on ampicillin , number of days of hospitalization and time to switch to oral therapy . A significant difference was noted between the two treatment modalities in terms of effectiveness and cost ( P < 0.05 ) . Conclusion : Overall , the endpoint of this study showed that the total cost per patient of ampicillin-treated group is cheaper than the total cost with the combination therapy ( ampicillin plus gentamicin ) and reduced unnecessary exposure to adverse effects or toxicities . Besides that , addition of gentamicin in the treatment modalities will only increase the cost of treatment without introducing any changes in the treatment outcome Background To determine the cost-effectiveness of strategies of preferred antibiotic treatment with beta-lactam/macrolide combination or fluoroquinolone monotherapy compared to beta-lactam monotherapy . Methods Costs and effects were estimated using data from a cluster-r and omized cross-over trial of antibiotic treatment strategies , primarily from the reduced third payer perspective ( i.e. hospital admission costs ) . Cost-minimization analysis ( CMA ) and cost-effectiveness analysis ( CEA ) were performed using linear mixed models . CMA results were expressed as difference in costs per patient . CEA results were expressed as incremental cost-effectiveness ratios ( ICER ) showing additional costs per prevented death . Results A total of 2,283 patients were included . Crude average costs within 90 days from the reduced third payer perspective were € 4,294 , € 4,392 , and € 4,002 per patient for the beta-lactam monotherapy , beta-lactam/macrolide combination , and fluoroquinolone monotherapy strategy , respectively . CMA results were € 106 ( 95 % CI € -697 to € 754 ) for the beta-lactam/macrolide combination strategy and € -278 ( 95%CI € -991 to € 396 ) for the fluoroquinolone monotherapy strategy , both compared to the beta-lactam monotherapy strategy . The ICER was not statistically significantly different between the strategies . Other perspectives yielded similar results . Conclusions There were no significant differences in cost-effectiveness of strategies of preferred antibiotic treatment of CAP on non-ICU wards with either beta-lactam monotherapy , beta-lactam/macrolide combination therapy , or fluoroquinolone monotherapy . Trial registration The trial was registered with Clinical Trials.gov , number NCT01660204 , on May 2nd , 2012 OBJECTIVE To examine treatment costs of community-acquired pneumonia ( CAP ) in adult out patients given oral ( p.o . ) levofloxacin or cefuroxime axetil as initial therapy . STUDY DESIGN Patients with a primary diagnosis of CAP were enrolled in a multicenter , prospect i ve , r and omized , open-label , active-controlled Phase III clinical trial . Both in patients and out patients were assigned to 1 of 2 treatment groups : ( 1 ) intravenous ( i.v . ) or p.o . levofloxacin ; or ( 2 ) i.v . ceftriaxone and /or p.o . cefuroxime axetil . METHODS To make legitimate and meaningful cost comparisons between similar types of patients receiving dru 
    Output:
    
Economic evaluation of interventions for management of CAP to date supports cost-effectiveness of studied interventions .
However , evidence relates largely to antimicrobials choice in older population s in developed countries .