Cost-effective choice of antimicrobial therapy for serious infections |
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Authors: | Dr Milton C Weinstein PhD J Leighton Read MD Donald N MacKay MD James J Kresel PhD Howard Ashley M Div Katherine Taylor Halvorsen ScD H Christina Hutchings RN MBA |
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Institution: | (1) the Nutrition and Metabolism Laboratory, New England Deaconess Hospital, Boston;(2) the Departments of Medicine, Pharmacy Services, and Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire;(3) the College of Business Administration, Northeastern University, Boston;(4) the Division of Cost-Benefit Studies, Smith Kline Beckman Corporation, Philadelphia, Pennsylvania;(5) Institute for Health Research, Harvard School of Public Health, 677 Huntington Avenue, 02115 Boston, MA |
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Abstract: | The authors evaluated the financial and health implications of treatment choices for three serious classes of infection: hospital-acquired
pneumonia, intra-abdominal infection, and sepsis of unknown origin. Data were obtained from a systematic review of clinical
literature and published data bases, by written questionnaire from a panel of infectious disease authorities, and from actual
costs at a tertiary-care hospital. For pneumonia and sepsis, the third-generation cephalosporin evaluated (ceftizoxime) was
found to be less expensive than other regimens, when costs of dose preparation and administration, monitoring, and toxicity
were added to drug acquisition costs. The lowestcost regimen for intra-abdominal infection was metronidazole plus gentamicin.
Modest differences in efficacy would easily outweigh differences in toxicity, however, and could justify the use of more expensive
regimens (e.g., mezlocillin plus gentamicin for hospital-acquired pneumonia, and cefoxitin plus gentamicin for intra-abdominal
infection). If all regimens are assumed to be equally efficacious, then the third-generation cephalosporin was both lowest
in cost and, owing to its low toxicity, greatest in net health benefit.
Supported by a grant from Smith Kline and French Laboratories and by the Harvard Community Health Plan Foundation through
the Institute for Health Research, a joint program of the Harvard Community Health Plan and Harvard University. |
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Keywords: | antibiotics cost-effectiveness decision analysis cephalosporin ceftizoxime |
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