Cost-Effectiveness of omadacycline versus moxifloxacin as the initial treatment for community-acquired bacterial pneumonia in China

Introduction: Community-acquired bacterial pneumonia (CABP) remains a leading cause of hospitalization, morbidity, and mortality worldwide, with substantial clinical and economic burdens. Effective initial antibiotic therapy is critical to optimize patient outcomes and reduce healthcare costs. Omadacycline, a novel aminomethylcycline with broad-spectrum antibacterial activity and favorable pharmacokinetics, has been approved by the U.S. Food and Drug Administration for the treatment of CABP. Clinical studies have shown that omadacycline is non-inferior to moxifloxacin, a widely used respiratory fluoroquinolone, in terms of efficacy. However, the higher acquisition cost of omadacycline raises questions regarding its economic value, particularly in resource-limited healthcare systems such as China. Given the increasing emphasis on cost-effectiveness to guide formulary decisions, evaluating the economic viability of omadacycline relative to moxifloxacin is essential. Aim This study evaluated the cost-effectiveness of omadacycline versus moxifloxacin as initial treatment for CABP in China. Method A decision-tree model was constructed using TreeAge Pro 2020 to assess sequential intravenous (IV)-to-oral omadacycline versus moxifloxacin in adult patients with non-severe CABP. Parameter values were obtained from published literature, public databases, and clinician surveys. Incremental cost-effectiveness ratios (ICERs) were calculated, and sensitivity analyses were performed to assess model robustness. A regimen was considered cost-effective if the ICER fell below the willingness-to-pay (WTP) threshold of $19,012 per quality-adjusted life year (QALY). Results In the base-case analysis, omadacycline provided an additional 0.01 QALY at an incremental cost of $633.25, resulting in an ICER of $62,325/QALY—substantially exceeding the $19,012 threshold. The cost of oral and IV omadacycline were the most influential parameters. Two-way sensitivity analyses indicated that at least a 40% discount in oral omadacycline price and a 25% discount in IV omadacycline price would be required for cost-effectiveness. Omadacycline was optimal in 19.4% of 10,000 Monte Carlo simulations at the $19,012/QALY threshold. Province-specific WTP thresholds showed cost-effectiveness probabilities ranging from 3.2% (Gansu) to 29.1% (Beijing). Conclusion Omadacycline is not cost-effective compared to moxifloxacin as the initial treatment for CABP in China, unless significant price reductions are achieved.