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1.
J Arthroplasty ; 39(8S1): S323-S327, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38631513

RESUMO

BACKGROUND: Vancomycin and tobramycin have traditionally been used in antibiotic spacers. In 2020, our institution replaced tobramycin with ceftazidime. We hypothesized that the use of ceftazidime/vancomycin (CV) in antibiotic spacers would not lead to an increase in treatment failure compared to tobramycin/vancomycin (TV). METHODS: From 2014 to 2022, we identified 243 patients who underwent a stage I revision for periprosthetic joint infection. The primary outcome was a recurrent infection requiring antibiotic spacer exchange. We were adequately powered to detect a 10% difference in recurrent infection. Patients who had a prior failed stage I or two-stage revision for infection, acute kidney injury prior to surgery, or end-stage renal disease were excluded. Given no other changes to our spacer constructs, we estimated cost differences attributable to the antibiotic change. Chi-square and t-tests were used to compare the two groups. Multivariable logistic regressions were utilized for the outcomes. RESULTS: The combination of TV was used in 127 patients; CV was used in 116 patients. Within one year of stage I, 9.8% of the TV group had a recurrence of infection versus 7.8% of the CV group (P = .60). By final follow-up, results were similar (12.6 versus 8.6%, respectively, P = .32). Adjusting for potential risk factors did not alter the results. Cost savings for ceftazidime versus tobramycin are estimated to be $68,550 per one hundred patients treated. CONCLUSIONS: Replacing tobramycin with ceftazidime in antibiotic spacers yielded similar periprosthetic joint infection eradication success at a lower cost. While larger studies are warranted to confirm these efficacy and cost-saving results, our data justifies the continued investigation and use of ceftazidime as an alternative to tobramycin in antibiotic spacers.


Assuntos
Antibacterianos , Ceftazidima , Infecções Relacionadas à Prótese , Tobramicina , Vancomicina , Humanos , Tobramicina/administração & dosagem , Tobramicina/economia , Vancomicina/economia , Vancomicina/administração & dosagem , Vancomicina/uso terapêutico , Ceftazidima/administração & dosagem , Ceftazidima/economia , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/economia , Antibacterianos/economia , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Reoperação/economia , Resultado do Tratamento , Estudos Retrospectivos , Artroplastia do Joelho/efeitos adversos , Artroplastia de Quadril/instrumentação
2.
BMJ Open ; 14(8): e086039, 2024 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-39209783

RESUMO

OBJECTIVES: This analysis aims to better reflect the value of new antibiotic treatment strategies, thereby informing clinical antibiotic use, antimicrobial reimbursement and/or hospital formulary decision-making in China. DESIGN: We adapted a published and validated dynamic disease transmission and cost-effectiveness model to evaluate the clinical and economic outcomes of introducing a new antibiotic, ceftazidime/avibactam (CAZ-AVI) for treating resistant infections in Zhejiang province, China. Outcomes were assessed over a 10-year infectious period and an annual discount rate of 5%. Costs were extracted from the hospital's Health Information System (HIS) and obtained after data cleaning, aggregation and discounting. SETTING: The Chinese healthcare system perspective. PARTICIPANTS: 10 905 patients in a Chinese tier-3 hospital from 2018 to 2021 with any of the three common infections (complicated intra-abdominal infection (cIAI), hospital-acquired/ventilator-associated pneumonia (HAP/VAP) and infections with limited treatment options (LTO)) caused by three common resistant pathogens (Escherichia coli, Klebsiella spp. and Pseudomonas aeruginosa). INTERVENTIONS: (1) Current treatment strategy (piperacillin-tazobactam (pip/taz) and meropenem); (2) CAZ-AVI at the third line; (3) CAZ-AVI at the second line; (4) CAZ-AVI at the first line; (5) CAZ/AVI first line, two lines diversified (i.e., equal pip/taz and CAZ-AVI at the first line; meropenem at the last line) and (6) CAZ/AVI first line, all-lines diversified. PRIMARY OUTCOME MEASURES: Quality-adjusted life years (QALYs) lost, hospitalisation costs and incremental net monetary benefit (INMB) were used to assess cost-effectiveness. RESULTS: Over 10 years, the introduction of CAZ-AVI to the current treatment strategy led to lower hospitalisation costs and more QALYs across all five treatment strategies, with between 68 284 and 78 571 QALYs gained whilst saving up to US$236.37 for each additional QALY gained. The INMB of introducing CAZ-AVI is estimated up to US$3 550 811 878. CONCLUSIONS: Introducing CAZ-AVI had a positive impact on clinical and economic outcomes for treating antimicrobial resistance, and diversifying the antibiotics use early in the treatment might yield the best benefits.


Assuntos
Antibacterianos , Compostos Azabicíclicos , Ceftazidima , Análise Custo-Benefício , Humanos , Antibacterianos/uso terapêutico , Antibacterianos/economia , China , Ceftazidima/uso terapêutico , Ceftazidima/economia , Compostos Azabicíclicos/uso terapêutico , Compostos Azabicíclicos/economia , Combinação de Medicamentos , Anos de Vida Ajustados por Qualidade de Vida , Modelos Econômicos , Análise de Custo-Efetividade
3.
Int J Med Sci ; 8(4): 339-44, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21647326

RESUMO

PURPOSE: Antimicrobial resistance among microorganisms is a global concern. In 2003, a nationwide antibiotic restriction program (NARP) was released in Turkey. In this study we evaluated the effect of NARP on antibiotic consumption, antimicrobial resistance, and cost. MATERIALS AND METHODS: The data obtained from all of the four university hospitals, and one referral tertiary-care educational state hospital in Ankara. Antimicrobial resistance profiles of 14,233 selected microorganisms all grown in blood cultures and antibiotic consumption from 2001 to 2005 were analyzed retrospectively. RESULTS: A negative correlation was observed between the ceftriaxone consumption and the prevalence of ceftriaxone resistant E.coli and Klebsiella spp. (rho:-0.395, p:0.332 and rho:-0.627, p:0.037, respectively). The decreased usage of carbapenems was correlated with decreased carbapenems-resistant Pseudomonas spp. and Acinetobacter spp (rho:0.155, p:0.712 and rho:0.180, p:0.668, respectively for imipenem). Methicillin resistance rates of S.aureus were decreased from 44% to 41%. After two years of NARP 5,389,155.82 USD saving occurred. CONCLUSION: NARP is effective in lowering the costs and antibiotic resistance.


Assuntos
Antibacterianos/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Prescrições de Medicamentos/normas , Farmacorresistência Bacteriana , Política de Saúde , Acinetobacter/efeitos dos fármacos , Antibacterianos/economia , Antibacterianos/farmacologia , Cefepima , Ceftazidima/economia , Ceftazidima/farmacologia , Ceftazidima/uso terapêutico , Ceftriaxona/economia , Ceftriaxona/farmacologia , Ceftriaxona/uso terapêutico , Cefalosporinas/economia , Cefalosporinas/farmacologia , Cefalosporinas/uso terapêutico , Redução de Custos/estatística & dados numéricos , Infecção Hospitalar/epidemiologia , Custos de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/economia , Uso de Medicamentos/estatística & dados numéricos , Escherichia/efeitos dos fármacos , Hospitais/estatística & dados numéricos , Humanos , Imipenem/economia , Imipenem/farmacologia , Imipenem/uso terapêutico , Klebsiella/efeitos dos fármacos , Meropeném , Resistência a Meticilina , Ácido Penicilânico/análogos & derivados , Ácido Penicilânico/economia , Ácido Penicilânico/farmacologia , Ácido Penicilânico/uso terapêutico , Piperacilina/economia , Piperacilina/farmacologia , Piperacilina/uso terapêutico , Combinação Piperacilina e Tazobactam , Pseudomonas/efeitos dos fármacos , Staphylococcus aureus/efeitos dos fármacos , Teicoplanina/economia , Teicoplanina/farmacologia , Teicoplanina/uso terapêutico , Tienamicinas/economia , Tienamicinas/farmacologia , Tienamicinas/uso terapêutico , Turquia , Vancomicina/economia , Vancomicina/farmacologia , Vancomicina/uso terapêutico
4.
Clin Ther ; 42(5): 802-817, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32349879

RESUMO

PURPOSE: Ceftazidime/avibactam (CAZ-AVI) is a fixed-dose combination antibiotic approved in Europe and the United States for patients with hospital-acquired pneumonia, including ventilator-associated pneumonia (HAP/VAP). The economic benefits of a new drug such as CAZ-AVI are required to be assessed against those of available comparators, from the perspective of health care providers and payers, through cost-effectiveness and cost-utility analyses. The objective of this analysis was to compare the cost-effectiveness of CAZ-AVI versus meropenem in the empirical treatment of appropriate hospitalized patients with HAP/VAP caused by gram-negative pathogens, from the perspective of publicly funded health care in Italy (third-party perspective, based on the data from the REPROVE (Ceftazidime-Avibactam Versus Meropenem In Nosocomial Pneumonia, Including Ventilator-Associated Pneumonia) clinical study; ClinicalTrials.gov NCT01808092). METHODS: A patient-level, sequential simulation model of the HAP/VAP clinical course was developed using spreadsheet software. The analysis focused on direct medical costs. The time horizon of the model selected was 5 years, with an annual discount rate of 3% on costs and quality-adjusted life-years (QALYs). Clinical inputs for treatment comparisons were mainly obtained from the REPROVE clinical study data. In addition to clinical outcomes observed in the trial, the model incorporated impact of resistance pathogens, based on data from published studies and expert opinion. Certain assumptions were made for some model parameters due to a lack of data. FINDINGS: The analysis demonstrated that the intervention sequence (CAZ-AVI followed by colistin + high-dose meropenem) versus the comparator sequence (meropenem followed by colistin + high-dose meropenem) provided a better clinical cure rate (+13.52%), which led to a shorter hospital stay (-0.40 days per patient), and gains in the number of life-years (+0.195) and QALYs (+0.350) per patient. The intervention sequence had an estimated net incremental total cost of €1254 ($1401) per patient, and the estimated incremental cost-effectiveness ratio was €3581 ($4000) per QALY gained, well below the willingness-to-pay threshold of €30,000 ($33,507) per QALY in Italy. IMPLICATIONS: The model results showed that CAZ-AVI is expected to provide clinical benefits in hospitalized patients with HAP/VAP in Italy at an acceptable cost compared to meropenem.


Assuntos
Antibacterianos/economia , Compostos Azabicíclicos/economia , Ceftazidima/economia , Pneumonia Associada a Assistência à Saúde/economia , Meropeném/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Compostos Azabicíclicos/uso terapêutico , Ceftazidima/uso terapêutico , Análise Custo-Benefício , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Pneumonia Associada a Assistência à Saúde/tratamento farmacológico , Humanos , Itália , Masculino , Meropeném/uso terapêutico , Pessoa de Meia-Idade , Adulto Jovem
5.
Int J Antimicrob Agents ; 54(5): 633-641, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31202921

RESUMO

Ceftazidime/avibactam (CAZ-AVI) is a novel, fixed-dose combination antibiotic that has been approved in Europe and the United States for patients with complicated urinary tract infections (cUTIs) based on results of a Phase III, randomized, comparative study (RECAPTURE study). The present analysis evaluated cost-effectiveness of CAZ-AVI as an empirical treatment for hospitalized patients with cUTIs from the Italian publicly funded healthcare (third-party payer) perspective. A sequential, patient-level simulation model was developed that followed the clinical course of cUTI and generated 5000 pairs of identical patients (CAZ-AVI or imipenem as empirical treatment). The model included additional impact of resistant pathogens; patients who did not respond to empirical treatment were switched to second-line treatment of colistin+high dose carbapenem in both groups. The time horizon of the model was five years, with an annual discount rate of 3% applied to both costs and quality-adjusted life-years (QALYs). The analysis demonstrated that an intervention sequence (CAZ-AVI followed by colistin+high dose carbapenem) compared with a comparator sequence (imipenem followed by colistin+high dose carbapenem) was associated with a net incremental cost of €1015 per patient but provided better health outcomes in terms of clinical cure (97.65% vs. 91.08%; ∆ = 6.57%), shorter hospital stays (10.65 vs. 12.55 days; ∆ = 1.90 days), and QALYs gained per patient (4.190 vs. 4.063; ∆ = 0.126). The incremental cost-effectiveness ratio was €8039/QALY, which is well below the willingness-to-pay threshold of €30 000/QALY in Italy. The results showed that CAZ-AVI is expected to be a cost-effective treatment compared with imipenem for cUTI in Italy.


Assuntos
Antibacterianos/economia , Compostos Azabicíclicos/economia , Ceftazidima/economia , Análise Custo-Benefício/métodos , Imipenem/economia , Tempo de Internação/economia , Infecções Urinárias/tratamento farmacológico , Antibacterianos/uso terapêutico , Compostos Azabicíclicos/uso terapêutico , Carbapenêmicos/economia , Carbapenêmicos/uso terapêutico , Ceftazidima/uso terapêutico , Colistina/economia , Colistina/uso terapêutico , Combinação de Medicamentos , Europa (Continente) , Bactérias Gram-Negativas/efeitos dos fármacos , Humanos , Imipenem/uso terapêutico , Programas Nacionais de Saúde , Estados Unidos , Infecções Urinárias/microbiologia
6.
Artigo em Inglês | MEDLINE | ID: mdl-31890160

RESUMO

Background: The rising incidence of resistance to currently available antibiotics among pathogens, particularly Gram-negative pathogens, in complicated intra-abdominal infections (cIAIs) has become a challenge for clinicians. Ceftazidime/avibactam (CAZ-AVI) is a fixed-dose antibiotic approved in Europe and the United States for treating (in combination with metronidazole) cIAI in adult hospitalised patients who have limited or no alternative treatment options. The approval was based on the results of RECLAIM, a Phase III, parallel-group, comparative study (RECLAIM 1 [NCT01499290] and RECLAIM 2 [NCT01500239]). The objective of our study was to assess the cost-effectiveness of CAZ-AVI plus metronidazole compared with 1) ceftolozane/tazobactam plus metronidazole and 2) meropenem, as an empiric treatment for the management of cIAI in Italy. Methods: A sequential, patient-level simulation model, with a 5-year time horizon and 3% annual discount rate (applied to both costs and health benefits), was developed using Microsoft Excel® to demonstrate the clinical course of the disease. The impact of resistant pathogens was included as an additional factor. Results: In the base-case analysis, the CAZ-AVI sequence (CAZ-AVI plus metronidazole followed by a colistin + tigecycline + high-dose meropenem combination after treatment failure), when compared to sequences for ceftolozane/tazobactam (ceftolozane/tazobactam plus metronidazole followed by colistin + tigecycline + high-dose meropenem after treatment failure) and meropenem (meropenem followed by colistin + tigecycline + high-dose meropenem after treatment failure), had better clinical outcomes with higher cure rates (93.04% vs. 91.52%; 92.98% vs. 90.24%, respectively), shorter hospital stays (∆ = - 0.38 and ∆ = - 1.24 days per patient, respectively), and higher quality-adjusted life years (QALYs) gained per patient (4.021 vs. 3.982; 4.019 vs. 3.960, respectively). The incremental cost effectiveness ratio in the CAZ-AVI sequence was €4099 and €15,574 per QALY gained versus each comparator sequence, respectively, well below the willingness-to-pay threshold of €30,000 per QALY accepted in Italy. Conclusions: The model results demonstrated that CAZ-AVI plus metronidazole could be a cost-effective alternative when compared with other antibiotic treatment options, as it is expected to provide better clinical benefits in hospitalised patients with cIAI in Italy.


Assuntos
Antibacterianos/uso terapêutico , Compostos Azabicíclicos/uso terapêutico , Ceftazidima/uso terapêutico , Cefalosporinas/uso terapêutico , Análise Custo-Benefício , Infecções Intra-Abdominais/tratamento farmacológico , Meropeném/uso terapêutico , Tazobactam/uso terapêutico , Adulto , Antibacterianos/economia , Compostos Azabicíclicos/economia , Infecções Bacterianas/complicações , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/economia , Ceftazidima/economia , Cefalosporinas/economia , Combinação de Medicamentos , Hospitalização/economia , Humanos , Infecções Intra-Abdominais/economia , Infecções Intra-Abdominais/microbiologia , Itália , Meropeném/economia , Modelos Econômicos , Tazobactam/economia
7.
Value Health ; 11 Suppl 1: S33-8, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18387065

RESUMO

OBJECTIVE: This article presents the methodology and results of the pharmacoeconomic analysis of the Magnex Against Standard COmbination Therapy study comparing cefoperazone-sulbactam (Magnex) versus ceftazidime+ amikacin+metronidazole, in the treatment of intra-abdominal infections. METHODS: This prospective, open label, phase IV study was conducted at 17 study sites in India and randomized subjects to receive either cefoperazone-sulbactam or the combination. Pharmacoeconomic analysis was included as a secondary objective and conducted in the clinical efficacy-evaluable (CEE) and the successfully treated patients. All comparisons between treatment groups were conducted using analysis of variance (ANOVA) or Wilcoxon Two-Sample tests. All costs were reported as Indian Rupee (INR) and actual unit costs collected in 2006 were used for the analyses [1 USD approximately 40 INR; 1 Euro approximately 56 INR]. RESULTS: In the CEE and the successfully treated subset of patients, the average cost of treatment was numerically lower in the cefoperazone-sulbactam arm (not statistically significant). The analyses found that the cost-effectiveness ratio (CER) for cefoperazone-sulbactam was INR 17,640.53 and that for the comparator group was INR 22,075.16. Additionally, the incremental CER results showed that the cost of treatment was INR 21,505.59 lower per additional successfully treated patient in the cefoperazone-sulbactam group. CONCLUSIONS: The present study was the first of its kind to be conducted in the "price sensitive" Indian health-care setting. Though study was not powered for the difference in average cost of treatments, there was a trend favoring cefoperazone sulbactam. The findings from this study should encourage further conduct of similar analyses and increase the knowledge regarding pharmacoeconomics in India.


Assuntos
Abdome/microbiologia , Antibacterianos/economia , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Cefoperazona/economia , Cefoperazona/uso terapêutico , Sulbactam/economia , Sulbactam/uso terapêutico , Adolescente , Adulto , Amicacina/economia , Amicacina/uso terapêutico , Ceftazidima/economia , Ceftazidima/uso terapêutico , Análise Custo-Benefício , Quimioterapia Combinada , Farmacoeconomia , Feminino , Humanos , Índia , Masculino , Metronidazol/economia , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Resultado do Tratamento
8.
Surg Neurol ; 68(2): 145-8; discussion 148, 2007 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17537487

RESUMO

BACKGROUND: The aim of this study is to evaluate the rate of infectious complications post endoscopic transspheinodal neurosurgery in patients receiving a new antibiotic chemoprophylaxis regimen. METHODS: Clinical records of 170 patients who received prophylaxis with a third-generation cephalosporin plus aminoglycoside (160 cases) or alone (10 cases) were retrospectively analyzed. Twenty-eight patients (16.4%) had CSF leakage. The postsurgical follow-up ranged from 3 months to 4 years. RESULTS: Of 170 patients, 2 (1.17%) developed infectious complications: 1 case of meningitis by Staphylococcus epidermidis and 1 case of sphenoid sinusitis (without microbiological diagnosis). In addition, asymptomatic sphenoid sinusitis was diagnosed in 2 other patients. The cost ranged from 22.50 to 33.34 euros/d. CONCLUSIONS: The rate of infectious complications was very low in patients receiving prophylaxis with a third-generation cephalosporin plus aminoglycoside or alone; because of the broad-spectrum of antibiotics and their high cost, this regimen could be used in at-risk patients (eg, smokers, patients with cerebrospinal leak, or patients with Cushing diseases).


Assuntos
Amicacina/administração & dosagem , Antibacterianos/administração & dosagem , Antibioticoprofilaxia/métodos , Ceftazidima/administração & dosagem , Ceftriaxona/administração & dosagem , Infecção da Ferida Cirúrgica/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Amicacina/economia , Antibacterianos/economia , Antibioticoprofilaxia/economia , Ceftazidima/economia , Ceftriaxona/economia , Análise Custo-Benefício , Esquema de Medicação , Quimioterapia Combinada , Endoscopia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cavidade Nasal/cirurgia , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/etiologia
9.
Bone Marrow Transplant ; 37(4): 373-9, 2006 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-16400334

RESUMO

Piperacillin/tazobactam was compared with ceftazidime for the empirical treatment of febrile neutropenia in patients with acute leukemia or following autologous peripheral blood stem cell transplantation. Owing to inclusion criteria, it was possible for the same patient to be randomized several times. A total of 219 individual patients were admitted to a prospective randomized clinical study: 24 patients were included twice. Patients (23.5%) remained afebrile. Patients who developed febrile neutropenia were randomized to receive intravenous ceftazidime (n = 74 patients, group I) or piperacillin/tazobactam (n = 87 patients, group II). Response to first-line antibiotic treatment was seen in 55% (group I) and 53% (group II). After the addition of vancomycin, a further 19% (group I) and 24% (group II) of the patients became afebrile. Causes of fever were: microbiologically documented infection in 36 and 34 patients of group I and II; Clostridium difficile in eight and 12 patients of group I and II, and fever of unknown origin in 30 and 41 patients of group I and II. One patient died in each group. Single-agent therapy with piperacillin/tazobactam is as effective as ceftazidime in the treatment of neutropenic fever and is well tolerated. Direct and indirect costs of both treatment regimes are equivalent.


Assuntos
Ceftazidima/uso terapêutico , Febre/tratamento farmacológico , Leucemia/complicações , Neutropenia/complicações , Ácido Penicilânico/análogos & derivados , Transplante de Células-Tronco de Sangue Periférico , Piperacilina/uso terapêutico , Doença Aguda , Adulto , Idoso , Antibacterianos/economia , Antibacterianos/uso terapêutico , Ceftazidima/economia , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Feminino , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Ácido Penicilânico/economia , Ácido Penicilânico/uso terapêutico , Transplante de Células-Tronco de Sangue Periférico/efeitos adversos , Piperacilina/economia , Valor Preditivo dos Testes , Estudos Prospectivos , Taxa de Sobrevida , Tazobactam , Transplante Autólogo , Resultado do Tratamento
10.
Trans R Soc Trop Med Hyg ; 109(6): 416-8, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25972345

RESUMO

BACKGROUND: Melioidosis is a common community-acquired infectious disease in northeast Thailand associated with overall mortality of approximately 40% in hospitalized patients, and over 70% in severe cases. Ceftazidime is recommended for parenteral treatment in patients with suspected melioidosis. Meropenem is increasingly used but evidence to support this is lacking. METHODS: A decision tree was used to estimate the cost-effectiveness of treating non-severe and severe suspected acute melioidosis cases with either ceftazidime or meropenem. RESULTS: Empirical treatment with meropenem is likely to be cost-effective providing meropenem reduces mortality in severe cases by at least 9% and the proportion with subsequent culture-confirmed melioidosis is over 20%. CONCLUSIONS: In this context, treatment of severe cases with meropenem is likely to be cost-effective, while the evidence to support the use of meropenem in non-severe suspected melioidosis is not yet available.


Assuntos
Anti-Infecciosos/economia , Ceftazidima/economia , Melioidose/tratamento farmacológico , Tienamicinas/economia , Anti-Infecciosos/uso terapêutico , Ceftazidima/uso terapêutico , Análise Custo-Benefício , Feminino , Humanos , Masculino , Melioidose/economia , Melioidose/epidemiologia , Meropeném , Tailândia/epidemiologia , Tienamicinas/uso terapêutico , Resultado do Tratamento
11.
Pharmacotherapy ; 19(5): 641-7, 1999 May.
Artigo em Inglês | MEDLINE | ID: mdl-10331828

RESUMO

We assessed the clinical and economic impact of a new parenteral-toparenteral stepdown program involving ceftazidime for the treatment of febrile neutropenia. This was a two-phase (before and after), 12-month, single-center, prospective study with a historical control. Ninety-eight ceftazidime treatment courses (47 preintervention, 51 postintervention) were administered for management of febrile neutropenia in 85 adults with hematologic malignancies. Multidisciplinary creation and promotion of parenteral-to-parenteral ceftazidime stepdown criteria were applied at the discretion of the health care team. Patient demographics between phases were similar. Only 2 (4%) treatment courses before the intervention involved parenteral-to-parenteral dosage stepdown, compared with 34 (67%) after the intervention (p<0.00001). Mean number of total ceftazidime doses/treatment course and mean duration of therapy did not change between phases. Clinical cure or improvement was identified in 74% and 80% of treatment courses before and after the intervention, respectively. The two main reasons for discontinuing the drug before the intervention were recovery of neutrophil count (60%) and adverse reactions (19%). Neutrophil count recovery (59%) and hospital discharge (14%) were the two most common reasons for discontinuation after the intervention. Of 34 stepdown treatment courses after the intervention, 3 (9%) failed to meet established stepdown criteria, and 2 of these required stepdown reversal. Ancillary antibacterial drugs and treatment course outcomes were similar between phases. Total ceftazidime acquisition cost for 704 treatment days in the preintervention phase was $52,473 CAN compared with $54,778 CAN for 907 days of therapy in the postintervention phase. The mean acquisition cost/ceftazidime treatment course was $1100 CAN and did not differ between phases. The mean daily cost of ceftazidime therapy was lower after the intervention ($60.39 vs $74.54 CAN) as a result of a greater frequency of stepdown (p<0.001). Assuming an equivalent number of treatment days, the projected annual acquisition cost avoidance associated with this stepdown program was $19,900 CAN.


Assuntos
Ceftazidima/administração & dosagem , Febre/tratamento farmacológico , Neutropenia/tratamento farmacológico , Adulto , Ceftazidima/economia , Esquema de Medicação , Feminino , Neoplasias Hematológicas/complicações , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
12.
Pharmacotherapy ; 21(5): 549-55, 2001 May.
Artigo em Inglês | MEDLINE | ID: mdl-11349744

RESUMO

STUDY OBJECTIVE: To determine if continuous-infusion ceftazidime is more cost-effective and efficacious than intermittent infusion in patients with nosocomial pneumonia. DESIGN: Prospective, open-label, randomized trial. SETTING: Large, community teaching hospital. PATIENTS: Intensive care unit (ICU) patients with nosocomial pneumonia. INTERVENTIONS: Ceftazidime 3 g/day was administered as a continuous infusion or as 2 g 3 times/day by intermittent infusion to treat nosocomial pneumonia in the ICU. Patients also received tobramycin 7 mg/kg once/day. MEASUREMENTS AND MAIN RESULTS: Thirty-five patients were evaluable; 17 received continuous infusion and 18 intermittent infusion. Clinical efficacy (94% and 83% successful outcomes with continuous and intermittent infusion, respectively), adverse events, and length of stay did not vary significantly between groups. Costs associated with continuous infusion, $627 +/- 388, were significantly lower (p < or = 0.001) than with intermittent infusion, $1007 +/- 430. CONCLUSIONS: Continuous infusion of ceftazidime is a cost-effective alternative to intermittent infusion for nosocomial pneumonia in the ICU.


Assuntos
Ceftazidima/administração & dosagem , Ceftazidima/economia , Cefalosporinas/administração & dosagem , Cefalosporinas/economia , Infecção Hospitalar/economia , Pneumonia/economia , Adulto , Idoso , Análise Custo-Benefício/economia , Análise Custo-Benefício/métodos , Infecção Hospitalar/tratamento farmacológico , Esquema de Medicação , Feminino , Humanos , Infusões Intravenosas/métodos , Masculino , Pessoa de Meia-Idade , Pneumonia/tratamento farmacológico , Estudos Prospectivos , Resultado do Tratamento
13.
Pharmacoeconomics ; 7(1): 49-62, 1995 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-10155293

RESUMO

There is evidence to suggest that single-agent broad spectrum antibacterials may be cost-effective alternatives to combination antibiotics for the empirical management of febrile neutropenia in cancer patients. The objectives of the present study were 2-fold. The first objective was to compare the clinical effectiveness of ceftazidime monotherapy with that of 2 combination antibiotic regimens in cancer patients with febrile neutropenia. The 2 comparator regimens consisted of tobramycin plus piperacillin, either with (regimen 'CAP') or without (regimen 'AP') cefazolin. The second objective was to perform a cost-effectiveness analysis of the 3 regimens. Meta-analysis of randomised comparative trials between the 3 therapy groups was performed to determine the average overall response rate after 3 to 5 days of treatment. Seven clinical studies were selected for analysis. The overall incidence of adverse drug reactions (ADRs) was determined using the results of comparative and noncomparative studies. A comparative cost-analytic model was applied from a hospital perspective. The costs of primary therapy, hospitalisation, laboratory tests, routine patient care and treating ADRs were calculated, as were future costs. Monotherapy with ceftazidime was associated with an overall response rate of 63.5% and mean per-patient costs of $Can12,000 to $Can14,000. In comparison, regimen AP was associated with an overall response rate of 58.8% and mean costs of $Can13,000 to $Can16,000 per patient. The overall response rate in patients receiving CAP was 75.3%, and the mean cost per patient was $Can11,000 to $Can12,000. Thus, regimen CAP was the most cost-effective therapy from a hospital perspective.


Assuntos
Antibacterianos/economia , Antibacterianos/uso terapêutico , Ceftazidima/economia , Ceftazidima/uso terapêutico , Febre/tratamento farmacológico , Neoplasias/complicações , Neutropenia/tratamento farmacológico , Adolescente , Adulto , Ensaios Clínicos como Assunto , Análise Custo-Benefício , Custos de Medicamentos , Quimioterapia Combinada , Febre/economia , Custos de Cuidados de Saúde , Humanos , Pessoa de Meia-Idade , Neoplasias/economia , Neutropenia/economia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
14.
Am J Clin Oncol ; 18(5): 429-35, 1995 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-7572762

RESUMO

Aminoglycoside-containing combination therapy has been the standard empirical approach for febrile neutropenic cancer patients. With the advent of the broad-spectrum oral fluoroquinolones, it is now possible to evaluate an initial empirical alternative therapy. A prospective randomized study was conducted comparing oral ciprofloxacin plus penicillin V (group A) with amikacin plus carbenicillin or ceftazidime (group B). Main criteria for eligibility were febrile patients with solid tumor or nonlymphoblastic lymphoma, a Zubrod PS equal to 1 or 2, no diarrhea, mucositis, or long-term central venous catheter. A total of 108 consecutive neutropenic febrile episodes were randomized (5 exclusions); 55 episodes were assigned to group A and 48 to group B. Most febrile episodes were of unknown origin. There were 10 microbiologically documented episodes with two cases of bacteremia. Both regimens were well tolerated. Oral regimen was substantially cheaper than parenteral regimen. Treatment success without regimen modification was 94.5% for group A and 93.8% for group B (p = .86; CI -0.08-0.10). Oral therapy with ciprofloxacin and penicillin V is a safe alternative to standard parenteral therapy in this low-risk group of neutropenic patients, with unquestionable cost containment.


Assuntos
Amicacina/uso terapêutico , Carbenicilina/uso terapêutico , Ceftazidima/uso terapêutico , Ciprofloxacina/uso terapêutico , Quimioterapia Combinada/uso terapêutico , Neoplasias/complicações , Neutropenia/tratamento farmacológico , Neutropenia/etiologia , Penicilina V/uso terapêutico , Administração Oral , Adulto , Amicacina/administração & dosagem , Amicacina/economia , Carbenicilina/administração & dosagem , Carbenicilina/economia , Ceftazidima/administração & dosagem , Ceftazidima/economia , Ciprofloxacina/administração & dosagem , Ciprofloxacina/economia , Custos e Análise de Custo , Quimioterapia Combinada/economia , Feminino , Febre de Causa Desconhecida/tratamento farmacológico , Febre de Causa Desconhecida/economia , Febre de Causa Desconhecida/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/economia , Neutropenia/economia , Penicilina V/administração & dosagem , Penicilina V/economia , Estudos Prospectivos
15.
Can J Hosp Pharm ; 48(5): 276-83, 1995 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-10152782

RESUMO

A retrospective, cost-effectiveness analysis was performed on 106 clinically evaluable patients who participated in a multi-centre, randomized study of sequential IV/oral ciprofloxacin therapy versus ceftazidime for the treatment of nosocomial pneumonia. Although nearly half of the ciprofloxacin patients received sequential therapy, the majority were treated with a full IV regimen. Clinical success rates and antibiotic-related adverse events were similar for the ciprofloxacin and ceftazidime groups. Per patient and per day costs of antibiotic acquisition; preparation and administration; treatment of adverse events, and clinical failures were compared. Decision analysis revealed that ciprofloxacin therapy was cost-effective compared to ceftazidime 2 g q8h. Varying the probability of clinical success between 60-99% failed to change the economic decision; costs for ciprofloxacin were always lower than for ceftazidime. Further sensitivity analyses demonstrated that if the ceftazidime price was reduced by 50% (equivalent to 1 g q8h), treatment costs would be similar to ciprofloxacin therapy. Increasing the ciprofloxacin price by 50% (equivalent to a q8h frequency) produced per patient costs similar to ceftazidime, although ciprofloxacin therapy retained a lower cost per day (p < 0.0002). For the treatment of nosocomial pneumonia, ciprofloxacin therapy was cost-effective compared to ceftazidime.


Assuntos
Antibacterianos/economia , Ceftazidima/economia , Ciprofloxacina/economia , Infecção Hospitalar/tratamento farmacológico , Custos de Medicamentos , Pneumonia/tratamento farmacológico , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Canadá , Ceftazidima/administração & dosagem , Ciprofloxacina/administração & dosagem , Análise Custo-Benefício , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Serviço de Farmácia Hospitalar/economia , Estudos Retrospectivos , Resultado do Tratamento
18.
J Chemother ; 21(2): 188-92, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19423472

RESUMO

The aim of cystic fibrosis (CF) care is to improve both the life expectancy and quality of life of patients. However, rising costs and limited resources of health services must be taken into account. There are many different antibiotic strategies for therapy of Pseudomonas aeruginosa infection in CF patients. In this 5-year retrospective study we found that the cost of treatment of initial infection is considerably lower than the cost of treating chronic P. aeruginosa infections. The percentage distribution of costs of antibiotic treatment in relationship to the administration route was considerably different between outpatients and inpatients. We observed an increase in antibiotic costs with the age of the patient and the decrease in FEV(1)values. The implementation of early eradication treatment, in addition to decreasing the prevalence of patients chronically infected by P. aeruginosa, might also bring about a notable decrease in costs.


Assuntos
Antibacterianos/economia , Efeitos Psicossociais da Doença , Fibrose Cística/tratamento farmacológico , Fibrose Cística/economia , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/economia , Adulto , Antibacterianos/uso terapêutico , Ceftazidima/economia , Ceftazidima/uso terapêutico , Pré-Escolar , Doença Crônica , Ciprofloxacina/economia , Ciprofloxacina/uso terapêutico , Ácidos Clavulânicos/economia , Ácidos Clavulânicos/uso terapêutico , Colistina/economia , Colistina/uso terapêutico , Fibrose Cística/complicações , Humanos , Meropeném , Infecções por Pseudomonas/etiologia , Pseudomonas aeruginosa , Estudos Retrospectivos , Tienamicinas/economia , Tienamicinas/uso terapêutico , Ticarcilina/economia , Ticarcilina/uso terapêutico , Tobramicina/economia , Tobramicina/uso terapêutico
19.
Eur J Intern Med ; 19(8): 619-24, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19046729

RESUMO

BACKGROUND: Empirical antibiotic treatment for febrile neutropenia is well established. The best regimen is still controversial. The purpose of this study was to evaluate the efficacy, safety, and cost of a once daily high dose of ceftriaxone plus ciprofloxacin versus thrice daily ceftazidime plus amikacin in neutropenic febrile patients. METHODS: Ninety-five patients with febrile neutropenia were included in a prospective, controlled, randomized, non-blind, comparative study. Patients were randomly assigned to one of the treatment groups (63 to the ceftriaxone/ciprofloxacin group and 32 to the ceftazidime/amikacin group) and evaluated as successes or failures according to defined criteria. Daily assessments were made of all patients and all adverse events were recorded. RESULTS: The overall incidence of documented infections was 45.9%: 24/47 (51.1%) in the ceftriaxone/ciprofloxacin group and 10/27 (37%) in the ceftazidime/amikacin group. There was a significant difference in clinical efficacy between the groups (p=0.011) at the end of therapy. The ceftriaxone/ciprofloxacin group had an overall incidence of resolution and improvement of 95.7% in comparison to 75% in the ceftazidime/amikacin group. Thirty-nine organisms were isolated, 26 (66.67%) gram-negative and 13 (33.33%) gram-positive. There was a low incidence of adverse events in both groups. CONCLUSION: The combination of a single, high dose of ceftriaxone plus ciprofloxacin daily was more effective than the standard combination of thrice daily ceftazidime plus amikacin with no significant adverse events in either group.


Assuntos
Amicacina/administração & dosagem , Antibacterianos/administração & dosagem , Anti-Infecciosos/administração & dosagem , Infecções Bacterianas/tratamento farmacológico , Ceftazidima/administração & dosagem , Ceftriaxona/administração & dosagem , Ciprofloxacina/administração & dosagem , Neutropenia/complicações , Amicacina/efeitos adversos , Amicacina/economia , Antibacterianos/efeitos adversos , Antibacterianos/economia , Anti-Infecciosos/efeitos adversos , Anti-Infecciosos/economia , Infecções Bacterianas/etiologia , Infecções Bacterianas/prevenção & controle , Ceftazidima/efeitos adversos , Ceftazidima/economia , Ceftriaxona/efeitos adversos , Ceftriaxona/economia , Ciprofloxacina/efeitos adversos , Ciprofloxacina/economia , Análise Custo-Benefício , Custos de Medicamentos , Quimioterapia Combinada , Feminino , Febre/etiologia , Grécia , Humanos , Masculino , Pessoa de Meia-Idade , Neutropenia/etiologia , Estudos Prospectivos , Resultado do Tratamento
20.
Ann Pharmacother ; 27(7-8): 967-71, 1993.
Artigo em Inglês | MEDLINE | ID: mdl-8364284

RESUMO

OBJECTIVE: This study evaluated the prevalence and resulting costs of ceftazidime dosing in excess of product labeling recommendations in elderly hospitalized patients. Ceftazidime is a beta-lactam antibiotic excreted via glomerular filtration. According to product labeling, ceftazidime dosing can frequently be decreased in the elderly because glomerular filtration declines with age. METHODOLOGY: A multicenter, retrospective utilization audit involving 11 US academic medical centers examined 221 medical records of patients 65 years of age or older receiving ceftazidime (any brand, any indication). The creatinine clearance of each patient was estimated using the Cockcroft-Gault formula. RESULTS: Renal insufficiency, defined as an estimated creatinine clearance of less than 50 mL/min, was present in 111 of the patients (50 percent). Ceftazidime dosing in excess of product labeling recommendations was noted in 75 of those 111 (68 percent). The cost of excess ceftazidime dosing for those 75 patients (i.e., extra drug acquisition, preparation, administration) was $13,822.50. CONCLUSIONS: Although the dosage of ceftazidime required in a specific patient is based on many factors, ceftazidime is frequently overdosed in the elderly because renal function is not considered. Ceftazidime dose-adjustment in the elderly, based on the estimated creatinine clearance, can lead to cost savings. In the US, where hospital reimbursement by Medicare is based on diagnosis, institutions can realize direct cost savings.


Assuntos
Centros Médicos Acadêmicos/economia , Ceftazidima/administração & dosagem , Ceftazidima/economia , Custos de Medicamentos , Uso de Medicamentos , Insuficiência Renal/metabolismo , Idoso , Idoso de 80 Anos ou mais , Ceftazidima/farmacocinética , Redução de Custos , Creatinina/metabolismo , Coleta de Dados , Uso de Medicamentos/economia , Feminino , Humanos , Masculino , Taxa de Depuração Metabólica , Estudos Retrospectivos , Estados Unidos
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