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Cost-minimization analysis of oral versus intravenous antibiotic treatment for Klebsiella penumoniae liver abscess

Published in Nature’s Scientific Report, this cost-minimization analysis compared oral and intravenous antibiotic treatment for Klebsiella pneumoniae liver abscess in a non-inferiority trial.

Healthcare service utilization and cost data were obtained from medical records and estimated from self-reported patient surveys in a non-inferiority trial of oral ciprofloxacin versus intravenous (IV) ceftriaxone administered to 152 hospitalised adults with KLA in Singapore between November 2013 and October 2017. Total costs were evaluated by category and payer and compared between oral and IV antibiotic groups over the trial period of 12 weeks.


This analysis found oral ciprofloxacin to be non-inferior to IV ceftriaxone in terms of clinical outcomes. Among the subset of 139 patients for whom cost data were collected, average total cost over 12 weeks was SGD16.378 (95% CI, SGD14,620 - SGD18,136) for the oral ciprofloxacin group and SGD20,569 (95% CI,SGD18,296-SGD22,842) for the IV ceftriaxone group, largely driven by lower average outpatient costs, as the average number of outpatient visits was halved for the oral ciprofloxacin group. There were no other statistically significant differences, either in inpatient costs or in other informal healthcare costs. Oral ciprofloxacin is less costly than IV ceftriaxone in the treatment of Klebsiella liver abscess, largely driven by reduced outpatient costs.


This study was co-authored by individuals from RFI (Joanne Yoong, Oliver Yuen), National University Hospital (James S. Molton, Jolene Oon, Brenda M. A. Salada, Dale Fisher, Sophia Archuleta), Tan Tock Seng Hospital (Ying Ding, Monica Chan, Barnaby Young, Tau Hong Lee, Ezlyn Izharuddin, David C. Lye), Agency for Care Effectiveness (Boon Piang Cher), Singapore General Hospital (Shirin Kalimuddin, Jenny Low, Li Min Wijaya), Duke-NUS Medical School (Jenny Low), Singapore Clinical Research Institute (Yuan Wei, Rajesh Moorakonda), and Imperial College London (Rachel Phillips).

Read the full study at

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