M T Halpern1, R E Brown, M Drolet, S V Sorensen, L A Mandell. 1. MEDTAP International, Bethesda, Maryland; Bristol-Myers Squibb, Montreal, Quebec; and Division of Infectious Diseases, McMaster University, Hamilton, Ontario.
Abstract
OBJECTIVE: To evaluate the comparative cost of treatment and intermediate outcomes (percentage resistant organisms, days in hospital, etc) among cefepime and alternative parenteral antibiotics used for empiric monotherapy. DESIGN: Decision analysis model, based on published literature, clinical trial results and information from infectious disease clinicians. SETTING: A Canadian tertiary care hospital. INTERVENTION: Comparison of cefepime, ceftazidime, ceftriaxone, cefotaxime and ciprofloxacin in the treatment of lower respiratory tract infections, urinary tract infections, skin/soft tissue infections, septicemia and febrile neutropenia. MAIN RESULTS: Cefepime treatment results in the lowest average cost per patient when used as initial empiric therapy for lower respiratory tract infections and for skin/soft tissue infections. Cefepime therapy is among the lowest cost treatments for the other infectious disease conditions and has the lowest cost for a weighted 'average' condition. Sensitivity analysis indicates that model results are most sensitive to duration of hospitalization. CONCLUSIONS: Initial empiric monotherapy with cefepime for serious infectious disease conditions may result in cost savings compared with alternative parenteral agents.
OBJECTIVE: To evaluate the comparative cost of treatment and intermediate outcomes (percentage resistant organisms, days in hospital, etc) among cefepime and alternative parenteral antibiotics used for empiric monotherapy. DESIGN: Decision analysis model, based on published literature, clinical trial results and information from infectious disease clinicians. SETTING: A Canadian tertiary care hospital. INTERVENTION: Comparison of cefepime, ceftazidime, ceftriaxone, cefotaxime and ciprofloxacin in the treatment of lower respiratory tract infections, urinary tract infections, skin/soft tissue infections, septicemia and febrile neutropenia. MAIN RESULTS:Cefepime treatment results in the lowest average cost per patient when used as initial empiric therapy for lower respiratory tract infections and for skin/soft tissue infections. Cefepime therapy is among the lowest cost treatments for the other infectious disease conditions and has the lowest cost for a weighted 'average' condition. Sensitivity analysis indicates that model results are most sensitive to duration of hospitalization. CONCLUSIONS: Initial empiric monotherapy with cefepime for serious infectious disease conditions may result in cost savings compared with alternative parenteral agents.
Authors: P R Murray; R N Jones; S D Allen; M E Erwin; P C Fuchs; E H Gerlach Journal: Diagn Microbiol Infect Dis Date: 1993 Mar-Apr Impact factor: 2.803