Cost-analysis of imipenem-cilastatin monotherapy compared with clindamycin+aminoglycoside combination therapy for treatment of serious lower respiratory, intra-abdominal, gynecologic, and urinary tract infections.

To determine the cost relative to efficacy and tolerability of two antimicrobial regimens, a prospective, multicenter study compared imipenem-cilastatin (I-C) monotherapy with clindamycin+aminoglycoside (C+A) in the treatment of serious lower respiratory, intra-abdominal, gynecologic, and urinary tract infections. The costs of acquiring, preparing, administering, and monitoring both regimens were obtained for 350 (99.4%) of 352 patients evaluated for efficacy; 170 were treated with I-C and 182 with C+A. Average acquisition costs per patient course of study antibiotic therapy were higher for I-C than for C+A (mean, $329 vs $119, respectively; P = 0.0001). This was offset, however, by greater costs in the C+A group for dosage preparation, material and labor, and need for therapeutic drug monitoring of the aminoglycoside. In addition, a greater proportion of patients failed C+A therapy than I-C therapy, leading to increased costs relating to extended hospitalization and subsequent antimicrobial therapy. Overall, the average total cost per patient course of study antibiotic therapy was numerically but not statistically lower for the I-C group than for the C+A group ($507 vs $813, respectively).

RCT Entities:   Population Interventions Outcomes