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1.
J Emerg Med ; 67(2): e217-e229, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-38825531

RESUMEN

BACKGROUND: A pathway for the treatment of acute bacterial skin and skin structure infections (ABSSSI) with a single intravenous (IV) dose of dalbavancin was previously shown to reduce hospital admissions and shorten inpatient length of stay (LOS). OBJECTIVES: To describe pathway implementation at the emergency department (ED) and evaluate cost-effectiveness of a single-dose dalbavancin administered to ED patients who would otherwise be hospitalized to receive usual care with multidose IV antibiotics. METHODS: The dalbavancin pathway was previously implemented at 11 U.S. EDs (doi:10.1111/acem.14258). Patients with ABSSSI, without an unstable comorbidity or infection complication requiring complex management, were treated with a single dose of dalbavancin. At the emergency physicians' discretion, patients were either discharged and received outpatient follow-up or were hospitalized for continued management. A decision analytic cost-effectiveness model was developed from the U.S. healthcare's perspective to evaluate costs associated with the dalbavancin pathway compared with inpatient usual care. Costs (2021 USD) were modeled over a 14-day horizon and included ED visits, drug costs, inpatient stay, and physician visits. One-way and probabilistic sensitivity analyses examined input parameter uncertainty. RESULTS: Driven largely by the per diem inpatient cost and LOS for usual care, the dalbavancin pathway was associated with savings of $5133.20 per patient and $1211.57 per hospitalization day avoided, compared with inpatient usual care. The results remained robust in sensitivity and scenario analyses. CONCLUSION: The new single-dose dalbavancin ED pathway for ABSSSI treatment, which was previously implemented at 11 U.S. EDs, offers robust cost savings compared to inpatient usual care.


Asunto(s)
Antibacterianos , Ahorro de Costo , Análisis Costo-Beneficio , Servicio de Urgencia en Hospital , Enfermedades Cutáneas Bacterianas , Teicoplanina , Humanos , Teicoplanina/análogos & derivados , Teicoplanina/administración & dosificación , Teicoplanina/uso terapéutico , Teicoplanina/economía , Servicio de Urgencia en Hospital/organización & administración , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Antibacterianos/economía , Enfermedades Cutáneas Bacterianas/tratamiento farmacológico , Tiempo de Internación/estadística & datos numéricos , Administración Intravenosa
2.
J Glob Antimicrob Resist ; 38: 306-308, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-38821442

RESUMEN

BACKGROUND: Many patients with cellulitis are treated with oral antibiotics as outpatients, but some require hospital admission for intravenous antibiotics. During the coronavirus disease 2019 pandemic, Betsi Cadwaladr University Health Board in Wales approved use of dalbavancin as first-line intravenous antibiotic from April to December 2020 to facilitate early discharge and prevent hospital admission. OBJECTIVES: To report cost savings and admission avoidance through first-line intravenous use of dalbavancin for cellulitis in one health board in Wales. PATIENTS AND METHODS: Patients with cellulitis who presented to the emergency department or medical assessment unit at Betsi Cadwaladr University Health Board's two hospitals between April and December 2020 were identified for treatment with dalbavancin, because they had not responded to oral antibiotics or their initial presentation warranted intravenous antibiotics. Patients received 1500 mg dalbavancin by intravenous infusion according to prescribing information and were sent home without being admitted. Outcomes were admission within 30 d of dalbavancin and cost savings from avoiding admission. RESULTS: 31 patients were treated with dalbavancin for cellulitis in the emergency department or medical assessment unit. No patient was admitted within 30 d of receiving dalbavancin. Use of dalbavancin is estimated to have saved 248 bed-days over the study period, with an estimated saving of $120,444.23 based on avoidance of admission. The cost of dalbavancin for these 31 patients was $69,959.08, giving an overall cost saving of $50,485.15 ($1529.95 per patient). CONCLUSIONS: Prescribing dalbavancin as first-line intravenous antibiotic for cellulitis prevents admission, saving bed-days and admission-related costs.


Asunto(s)
Antibacterianos , Celulitis (Flemón) , Hospitalización , Teicoplanina , Humanos , Teicoplanina/análogos & derivados , Teicoplanina/uso terapéutico , Teicoplanina/economía , Teicoplanina/administración & dosificación , Celulitis (Flemón)/tratamiento farmacológico , Celulitis (Flemón)/economía , Masculino , Femenino , Persona de Mediana Edad , Antibacterianos/uso terapéutico , Antibacterianos/economía , Anciano , Adulto , COVID-19 , SARS-CoV-2 , Ahorro de Costo , Anciano de 80 o más Años
3.
Am J Health Syst Pharm ; 81(Supplement_2): S40-S48, 2024 May 24.
Artículo en Inglés | MEDLINE | ID: mdl-38465838

RESUMEN

PURPOSE: Persons who inject drugs (PWID) are at risk for severe gram-positive infections and may require prolonged hospitalization and intravenous (IV) antibiotic therapy. Dalbavancin (DBV) is a long-acting lipoglycopeptide that may reduce costs and provide effective treatment in this population. METHODS: This was a retrospective review of PWID with severe gram-positive infections. Patients admitted from January 1, 2017, to November 1, 2019 (standard-of-care [SOC] group) and from November 15, 2019, to March 31, 2022 (DBV group) were included. The primary outcome was the total cost to the healthcare system. Secondary outcomes included hospital days saved and treatment failure. RESULTS: A total of 87 patients were included (37 in the DBV group and 50 in the SOC group). Patients were a median of 34 years old and were predominantly Caucasian (82%). Staphylococcus aureus (82%) was the most common organism, and bacteremia (71%) was the most common type of infection. Compared to the SOC group, the DBV group would have had a median of 14 additional days of hospitalization if they had stayed to complete their therapy (P = 0.014). The median total cost to the healthcare system was significantly lower in the DBV group than in the SOC group ($31,698.00 vs $45,093.50; P = 0.035). The rate of treatment failure was similar between the groups (32.4% in the DBV group vs 36% in the SOC group; P = 0.729). CONCLUSION: DBV is a cost-saving alternative to SOC IV antibiotics for severe gram-positive infections in PWID, with similar treatment outcomes. Larger prospective studies, including other patient populations, may demonstrate additional benefit.


Asunto(s)
Antibacterianos , Infecciones por Bacterias Grampositivas , Hospitalización , Teicoplanina , Humanos , Teicoplanina/análogos & derivados , Teicoplanina/uso terapéutico , Teicoplanina/economía , Teicoplanina/administración & dosificación , Estudios Retrospectivos , Antibacterianos/economía , Antibacterianos/uso terapéutico , Antibacterianos/administración & dosificación , Masculino , Femenino , Adulto , Hospitalización/economía , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/economía , Persona de Mediana Edad , Abuso de Sustancias por Vía Intravenosa/complicaciones , Abuso de Sustancias por Vía Intravenosa/tratamiento farmacológico , Tiempo de Internación , Nivel de Atención , Índice de Severidad de la Enfermedad , Adulto Joven
4.
Int J Antimicrob Agents ; 54(5): 652-654, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31398481

RESUMEN

Dalbavancin is a lipoglycopeptide antibiotic with unique weekly dosing active against Gram-positive organisms. This retrospective study included 37 patients receiving a mean of 2.7 weeks of dalbavancin. Nine patients (24%) were re-admitted to the hospital within 30 days. A total of 617 hospital days were saved, estimated to result in US$1 495 336 in savings and a mean cost avoidance of US$40 414 per patient. Dalbavancin provides a valuable antibiotic option that may minimise healthcare expenditure.


Asunto(s)
Antibacterianos/economía , Ahorro de Costo/economía , Infecciones por Bacterias Grampositivas/economía , Tiempo de Internación/economía , Teicoplanina/análogos & derivados , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Femenino , Bacterias Grampositivas/efectos de los fármacos , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Enfermedades Cutáneas Bacterianas/tratamiento farmacológico , Infecciones de los Tejidos Blandos/tratamiento farmacológico , Teicoplanina/economía , Teicoplanina/uso terapéutico , Adulto Joven
5.
Expert Rev Pharmacoecon Outcomes Res ; 19(5): 581-599, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30714834

RESUMEN

Background: The aim of this study was to develop a spending predictor model to evaluate the direct costs associated with the management of ABSSSIs from the National health-care provider's perspective of Italy, Romania, and Spain. Methodology: A decision-analytic model was developed to evaluate the diagnostic and clinical pathways of hospitalized ABSSSI patients based on scientific guidelines and real-world data. A Standard of Care (SoC) scenario was compared with a dalbavancin scenario in which the patients could be discharged early. The epidemiological and cost parameters were extrapolated from national administrative databases (i.e., hospital information system). A probabilistic sensitivity analysis (PSA) and one-way sensitivity analysis (OWA) were performed. Results: Overall, the model estimated an average annual number of patients with ABSSSIs of approximately 50,000 in Italy, Spain, and Romania. On average, the introduction of dalbavancin reduced the length of stay by 3.3 days per ABSSSI patient. From an economic perspective, dalbavancin did not incur any additional cost from the National Healthcare perspective, and the results were consistent among the countries. The PSA and OWA demonstrated the robustness of these results. Conclusion: This model represents a useful tool for policymakers by providing information regarding the economic and organizational consequences of an early discharge approach in ABSSSI management.


Asunto(s)
Antibacterianos/administración & dosificación , Modelos Económicos , Enfermedades Cutáneas Bacterianas/tratamiento farmacológico , Teicoplanina/análogos & derivados , Enfermedad Aguda , Antibacterianos/economía , Simulación por Computador , Análisis Costo-Beneficio , Técnicas de Apoyo para la Decisión , Hospitalización/economía , Humanos , Italia , Tiempo de Internación , Rumanía , Enfermedades Cutáneas Bacterianas/economía , España , Teicoplanina/administración & dosificación , Teicoplanina/economía
6.
Expert Opin Pharmacother ; 19(4): 319-325, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29509504

RESUMEN

INTRODUCTION: Acute bacterial skin and skin-structure infections (ABSSSI) are common infectious diseases (ID) that often require intravenous (IV) antibiotics. Dalbavancin is a novel lipoglycopeptide antibiotic administered once that is FDA-approved for the treatment of ABSSSI. No literature is available for real-world cost-comparability relative to conventional therapy. METHODS: This retrospective chart review examined adults diagnosed with ABSSSI and treated with IV antibiotics at an outpatient ID clinic after hospital discharge from January 2015 to August 2016. Patients received either dalbavancin or conventional therapy. In-hospital baseline demographics as well as outpatient clinical variables and outcomes were assessed. The primary outcome was the total ID-related cost of care per patient. A Monte Carlo probalistic sensitivity analysis was conducted. RESULTS: One hundred and fifty-eight patients were included: 64 received dalbavancin and 94 received conventional therapy. The total ID-related cost of care per patient was greater with dalbavancin (mean $4,561) vs conventional (mean $1,668), p < 0.01. In the subset of patients treated with daptomycin, the total ID-related cost (mean $5,218) was comparable to dalbavancin (mean $4,561). CONCLUSIONS: Dalbavancin was more costly than conventional therapy for the outpatient treatment of ABSSSI. This greater overall cost was likely driven by the higher acquisition cost of dalbavancin. Dalbavancin may be comparable to the daily use of daptomycin for ABSSSI.


Asunto(s)
Antibacterianos/economía , Costos y Análisis de Costo , Enfermedades Cutáneas Bacterianas/economía , Teicoplanina/análogos & derivados , Enfermedad Aguda , Administración Intravenosa , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Método de Montecarlo , Pacientes Ambulatorios , Estudios Retrospectivos , Enfermedades Cutáneas Bacterianas/tratamiento farmacológico , Teicoplanina/economía , Teicoplanina/uso terapéutico , Adulto Joven
7.
Expert Opin Drug Metab Toxicol ; 14(2): 197-206, 2018 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-29258361

RESUMEN

INTRODUCTION: Acute bacterial skin and skin structure infections (ABSSIs), defined as a bacterial infection of the skin with a lesion size area of at least 75 cm, are a leading cause of hospital admission and ambulatory care visits worldwide. Dalbavancin is a lipoglycopeptide antibiotic recently approved by the United States Food and Drug Administration (FDA) and by European Medicines Agency (EMA) for ABSSSIs. The authors review and provide updates of efficacy and safety by several studies on dalbavancin. Areas covered: A PubMed search was performed for relevant literature. We especially focused our attention on pharmacokinetics. Expert opinion: Dalbavancin provides an important new therapy for management of ABSSI, maintaining a spectrum of activity similar to vancomycin against gram-positive organisms. Use of dalbavancin, with its 1-week-shot treatment, consist in a reduction of the length of hospital stay or in a reduction of hospital admissions, with important cost savings.


Asunto(s)
Antibacterianos/administración & dosificación , Enfermedades Cutáneas Bacterianas/tratamiento farmacológico , Teicoplanina/análogos & derivados , Animales , Antibacterianos/economía , Antibacterianos/farmacocinética , Ahorro de Costo , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/economía , Infecciones por Bacterias Grampositivas/microbiología , Hospitalización/estadística & datos numéricos , Humanos , Tiempo de Internación , Enfermedades Cutáneas Bacterianas/economía , Enfermedades Cutáneas Bacterianas/microbiología , Teicoplanina/administración & dosificación , Teicoplanina/economía , Teicoplanina/farmacocinética , Vancomicina/uso terapéutico
8.
Clin Microbiol Infect ; 24(4): 361-368, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-28882727

RESUMEN

OBJECTIVES: Skin and soft tissue infections (SSTIs) carry significant economic burden, as well as morbidity and mortality, especially when caused by methicillin-resistant Staphylococcus aureus (MRSA). Several new MRSA-active antibiotics have been developed, including semisynthetic glycopeptides (telavancin, dalbavancin and oritavancin). Of these, dalbavancin and oritavancin offer extended dosing intervals. METHODS: We performed a systematic review, network meta-analysis and cost analysis to compare the newer glycopeptides to standard care and to each other for the treatment of complicated SSTIs (cSSTI). A search for randomized controlled trials (RCTs) was conducted in Medline, Embase and the Cochrane Central Register of Controlled Trials. We also developed a model to evaluate the costs associated with dalbavancin and oritavancin from the third-party payer perspective. RESULTS: Seven RCTs met the inclusion criteria. Network meta-analyses suggested that the clinical response to telavancin, dalbavancin and oritavancin was similar to standard care (odds ratio (OR) 1.09, 95% confidence interval (CI) 0.90-1.33; OR 0.78, 95% CI 0.52-1.18; and OR 1.06, 95% CI 0.85-1.33, respectively). Head-to-head comparisons showed no difference in clinical response between oritavancin and dalbavancin (OR 1.36; 95% CI 0.85-2.18), oritavancin and telavancin (OR 0.98; 95% CI 0.72-1.31) or dalbavancin and telavancin (OR 0.72; 95% CI 0.45-1.13). Telavancin had a higher incidence of overall adverse events compared to standard care (OR 1.33; 95% CI 1.10-1.61). Compared to telavancin, there were fewer overall adverse events with dalbavancin (OR 0.58; 95% CI 0.45-0.76) and oritavancin (OR 0.71; 95% CI 0.55-0.92). Studies were of high quality overall. Our cost analyses demonstrated that dalbavancin and oritavancin were less costly compared to standard care under baseline assumptions and many scenarios evaluated. The use of dalbavancin could save third-party payers $1442 to $4803 per cSSTI, while the use of oritavancin could save $3571 to $6932 per cSSTI. CONCLUSIONS: Dalbavancin and oritavancin demonstrate efficacy and safety comparable to standard care in well-designed RCTs and result in cost savings when standard care is treatment that covers MRSA.


Asunto(s)
Antibacterianos/uso terapéutico , Glicopéptidos/uso terapéutico , Enfermedades Cutáneas Bacterianas/tratamiento farmacológico , Infecciones de los Tejidos Blandos/tratamiento farmacológico , Antibacterianos/efectos adversos , Antibacterianos/economía , Costos y Análisis de Costo , Quimioterapia/economía , Quimioterapia/métodos , Glicopéptidos/efectos adversos , Glicopéptidos/economía , Humanos , Lipoglucopéptidos , Metaanálisis en Red , Teicoplanina/efectos adversos , Teicoplanina/análogos & derivados , Teicoplanina/economía , Teicoplanina/uso terapéutico
9.
Conn Med ; 80(3): 175-80, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-27169303

RESUMEN

The FDA guidance published in 2013 provided requirements for conducting ABSSSI trials. In 2014, dalbavancin, oritavancin, and tedizolid were introduced into the market after phase III noninferiority clinical trials against vancomycin (for the lipoglycopeptides) and linezolid (for tedizolid), demonstrating clinical efficacy for the treatment of ABSSSI. Great interest exists for these agents because of the postulated financial impact. Due to favorable pharmacokinetics which allow for less frequent medication administration and shorter treatment durations, these agents may prove to reduce hospital admissions and length of stay.


Asunto(s)
Glicopéptidos/farmacología , Organofosfatos/farmacología , Oxazoles/farmacología , Enfermedades Cutáneas Bacterianas/tratamiento farmacológico , Teicoplanina/análogos & derivados , Antibacterianos/economía , Antibacterianos/farmacología , Ensayos Clínicos Fase III como Asunto , Costos y Análisis de Costo , Glicopéptidos/economía , Humanos , Lipoglucopéptidos , Organofosfatos/economía , Oxazoles/economía , Guías de Práctica Clínica como Asunto , Teicoplanina/economía , Teicoplanina/farmacología , Resultado del Tratamiento
12.
Nephrology (Carlton) ; 16(8): 697-703, 2011 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-21707841

RESUMEN

AIM: Vancomycin and teicoplanin are the two most used glycopeptides for the treatment of methicillin-resistant Staphylococcus aureus (MRSA). Vancomycin is suspected to have more nephrotoxicity but this has not been clearly established. The aim of this study was to assess its nephrotoxicity by a consensus definition of acute kidney injury (AKI): the risk (R), injury (I), failure (F), loss and end-stage renal disease (RIFLE) classification. METHODS: Patients with MRSA bacteraemia who were prescribed either vancomycin or teicoplanin between 2003 and 2008 were classified. Patients who developed AKI were classified by RIFLE criteria. Variables such as comorbidities, laboratory data and medical cost information were also obtained from the database. Outcomes determined were: (i) the rate of nephrotoxicity and mortality; and (ii) the association of nephrotoxicity with the length of hospital stay and costs. RESULTS: The study included 190 patients (vancomycin 33, teicoplanin 157). Fifteen patients on vancomycin and 27 patients on teicoplanin developed AKI (P = 0.0004). In the vancomycin group, four, eight and three patients were classified to RIFLE criteria R, I and F, respectively. In the teicoplanin group, 17, nine and one patient were classified to RIFLE criteria R, I and F, respectively. Kaplan-Meier analysis showed significant difference in time to nephrotoxicity for the vancomycin group compared to the teicoplanin group. No significant differences were found between the groups in terms of total mortality, length of hospital stay and costs. CONCLUSION: The study data suggest that vancomycin is associated with a higher likelihood of nephrotoxicity using the RIFLE classification.


Asunto(s)
Lesión Renal Aguda/inducido químicamente , Antibacterianos/efectos adversos , Bacteriemia/tratamiento farmacológico , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Infecciones Estafilocócicas/tratamiento farmacológico , Vancomicina/efectos adversos , Lesión Renal Aguda/economía , Lesión Renal Aguda/mortalidad , Anciano , Anciano de 80 o más Años , Antibacterianos/administración & dosificación , Antibacterianos/economía , Bacteriemia/economía , Bacteriemia/mortalidad , Femenino , Costos de Hospital/estadística & datos numéricos , Humanos , Estimación de Kaplan-Meier , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Infecciones Estafilocócicas/economía , Infecciones Estafilocócicas/mortalidad , Teicoplanina/administración & dosificación , Teicoplanina/efectos adversos , Teicoplanina/economía , Vancomicina/administración & dosificación , Vancomicina/economía
13.
Int J Med Sci ; 8(4): 339-44, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21647326

RESUMEN

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.


Asunto(s)
Antibacterianos/uso terapéutico , Infección Hospitalaria/tratamiento farmacológico , Prescripciones de Medicamentos/normas , Farmacorresistencia Bacteriana , Política de Salud , Acinetobacter/efectos de los fármacos , Antibacterianos/economía , Antibacterianos/farmacología , Cefepima , Ceftazidima/economía , Ceftazidima/farmacología , Ceftazidima/uso terapéutico , Ceftriaxona/economía , Ceftriaxona/farmacología , Ceftriaxona/uso terapéutico , Cefalosporinas/economía , Cefalosporinas/farmacología , Cefalosporinas/uso terapéutico , Ahorro de Costo/estadística & datos numéricos , Infección Hospitalaria/epidemiología , Costos de los Medicamentos/estadística & datos numéricos , Utilización de Medicamentos/economía , Utilización de Medicamentos/estadística & datos numéricos , Escherichia/efectos de los fármacos , Hospitales/estadística & datos numéricos , Humanos , Imipenem/economía , Imipenem/farmacología , Imipenem/uso terapéutico , Klebsiella/efectos de los fármacos , Meropenem , Resistencia a la Meticilina , Ácido Penicilánico/análogos & derivados , Ácido Penicilánico/economía , Ácido Penicilánico/farmacología , Ácido Penicilánico/uso terapéutico , Piperacilina/economía , Piperacilina/farmacología , Piperacilina/uso terapéutico , Combinación Piperacilina y Tazobactam , Pseudomonas/efectos de los fármacos , Staphylococcus aureus/efectos de los fármacos , Teicoplanina/economía , Teicoplanina/farmacología , Teicoplanina/uso terapéutico , Tienamicinas/economía , Tienamicinas/farmacología , Tienamicinas/uso terapéutico , Turquía , Vancomicina/economía , Vancomicina/farmacología , Vancomicina/uso terapéutico
14.
J Chemother ; 20(5): 531-41, 2008 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-19028614

RESUMEN

The glycopeptides vancomycin and teicoplanin are widely used, and indeed recommended for, the treatment of severe or resistant Gram-positive infections. Therapeutic drug monitoring is widely used for vancomycin but less commonly for teicoplanin, and remains controversial. We report the cost savings of a formulary decision to replace teicoplanin with daptomycin for the empiric treatment of complicated skin and soft tissue infections (CSSTIs), staphylococcal bacteraemia and hospital-acquired Gram-positive sepsis. In the Intensive Therapy Unit (ITU) we optimised treatment of serious Gram-positive infections by substituting teicoplanin with vancomycin administered by continuous infusion. Costs were calculated using British National Formulary (BNF) prices and costs for therapeutic drug monitoring. Daptomycin (350 mg/d) use was associated with a cost saving per 7 days of treatment of 86 pounds and vancomycin with 51 pounds (4 g/d) to 276 pounds (2 g/d) compared to the 600 mg teicoplanin dose. Our own formulary re-positioning of glyco/lipopeptides, i.e. the preferential use of vancomycin in the ITU and substitution of teicoplanin with daptomycin, is cost-effective and provides better therapeutic alternatives. Continuous vancomycin infusion in the ITU setting guarantees optimal dosing for severely ill patients. Daptomycin use on surgical and medical wards, apart from being marginally cheaper than teicoplanin, guarantees optimal dosing without the need for drug monitoring.


Asunto(s)
Antibacterianos/economía , Daptomicina/economía , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Teicoplanina/economía , Vancomicina/economía , Antibacterianos/uso terapéutico , Daptomicina/uso terapéutico , Glicopéptidos/economía , Glicopéptidos/uso terapéutico , Humanos , Infusiones Intravenosas , Unidades de Cuidados Intensivos , Teicoplanina/uso terapéutico , Reino Unido , Vancomicina/administración & dosificación
15.
Pharm World Sci ; 30(6): 916-23, 2008 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-18803030

RESUMEN

OBJECTIVE: The aim of this study was to estimate and compare the costs of vancomycin and teicoplanin in the treatment of Gram-positive hospital infections in Turkey using a cost minimisation analysis. SETTING: Hacettepe University Hospital, Ankara, Turkey. METHOD: The health-care provider's perspective was considered within formal pharmacoeconomic assessment methodology. The records of 76 patients who had been hospitalised and treated for Gram-positive infections at Hacettepe University Hospital between 16 July 2003 and 22 November 2003 were retrospectively evaluated to obtain individual data on resources and associated costs. MAIN OUTCOME MEASURE: From a cost minimisation perspective, hospital directors may consider teicoplanin to be a relevant option in addition to vancomycin. RESULT: The estimated mean treatment cost per patient was 1,780 TRY (1,101 EUR) for teicoplanin and 1,429 TRY (884 EUR) for vancomycin, with statistical analysis failing to reveal any significant difference between the two drugs in terms of these total costs (p = 0.33). This cost minimisation analysis shows that the average costs of vancomycin and teicoplanin per patient observed did not differ significantly. CONCLUSION: Other potential advantages of one drug over the other, as reported by other authors, such as differing safety profiles or advantages in administration, may ultimately decide which is preferred.


Asunto(s)
Antibacterianos/economía , Infecciones por Bacterias Grampositivas/economía , Teicoplanina/economía , Vancomicina/economía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Costos y Análisis de Costo , Interpretación Estadística de Datos , Costos de los Medicamentos , Femenino , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Hospitales Universitarios/economía , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Teicoplanina/uso terapéutico , Turquía/epidemiología , Vancomicina/uso terapéutico , Adulto Joven
16.
Expert Opin Pharmacother ; 9(6): 987-1000, 2008 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-18377341

RESUMEN

BACKGROUND: New antibiotics efficacious in infections caused by resistant Gram-positive microorganisms and with acceptable costs for national health systems per unit of effectiveness are needed. OBJECTIVE: This paper aimed to summarize all available evidence regarding the pharmacoeconomics of linezolid. METHODS: A systematic review of pharmacoeconomic analyses through a non-restricted literature search was conducted. RESULTS/CONCLUSIONS: Linezolid, as compared to vancomycin and teicoplanin, results in a reduction of the necessary resources for the treatment of infections caused by Gram-positive microorganisms. These benefits are attributable to clinical outcomes and to savings associated with the ease of switching from intravenous to oral administration, the shorter duration of intravenous therapy and earlier hospital discharge. Likewise, linezolid, compared to vancomycin and teicoplanin, is a cost-effective treatment.


Asunto(s)
Acetamidas/economía , Acetamidas/uso terapéutico , Antibacterianos/economía , Antibacterianos/uso terapéutico , Oxazolidinonas/economía , Oxazolidinonas/uso terapéutico , Acetamidas/administración & dosificación , Antibacterianos/administración & dosificación , Ensayos Clínicos como Asunto , Costos y Análisis de Costo , Farmacorresistencia Bacteriana Múltiple , Humanos , Linezolid , Modelos Econométricos , Oxazolidinonas/administración & dosificación , Calidad de Vida , Staphylococcus aureus/efectos de los fármacos , Teicoplanina/economía , Teicoplanina/uso terapéutico , Vancomicina/economía , Vancomicina/uso terapéutico
17.
J Chemother ; 19(4): 398-409, 2007 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-17855184

RESUMEN

The aim of this study was to perform a comparative cost-effectiveness analysis of linezolid vs teicoplanin (i.v., switching to oral/i.m. respectively) in Spain. A decision tree model was used with the results of a randomized, comparative, controlled clinical trial with linezolid vs teicoplanin in the treatment of infections caused by Gram-positive microorganisms, with a timeline of 31 days. The efficacy endpoint was the percentage of patients with clinical healing or improvement in their infection. Direct medical costs were included using Spanish 2005 prices. Average cost per patient, average cost-effectiveness ratio and several sensitivity analyses were carried out. In the intent-to-treat (ITT) analysis linezolid obtained a higher percentage of therapeutic success than teicoplanin (95.5% vs 87.6% respectively, p = 0.005), both with similar tolerability. The average cost per treated patient was euro 8,064.76 for linezolid vs euro 8,727.36 for teicoplanin, with an incremental cost of euro 622.59 (-7,6%). Linezolid yielded a lower average cost-effectiveness ratio, euro 8,444.78 (8,195.90 - 8,709.25) than teicoplanin, euro 9,962.74 (9,465.68 - 10,502.23), with a slight reduction in average cost per successfully treated patient of 15.2% ( euro 1,517.96). The results were robust to the sensitivity analysis. In conclusion, linezolid is a more cost-effective option than teicoplanin in the treatment of infections caused by Gram-positive microorganisms, since it offers superior clinical benefits with a lower use of associated resources.


Asunto(s)
Acetamidas/economía , Antiinfecciosos/economía , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Oxazolidinonas/economía , Teicoplanina/economía , Acetamidas/uso terapéutico , Adulto , Anciano , Antiinfecciosos/uso terapéutico , Análisis Costo-Beneficio , Femenino , Costos de la Atención en Salud , Humanos , Linezolid , Masculino , Persona de Mediana Edad , Oxazolidinonas/uso terapéutico , España , Teicoplanina/uso terapéutico
18.
Rev Esp Quimioter ; 19(1): 65-75, 2006 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-16688294

RESUMEN

The objective of this study, conducted at Hospital Clínico San Carlos, Madrid, Spain, was to compare the cost of treatment of Gram-positive infections with teicoplanin and vancomycin under normal conditions. Using a prospective observational study design for drug utilization and economic assessment, we evaluated the comparability of the sample, adverse events, features of treatment with teicoplanin/vancomycin and factors influencing the consumption of resources until the end of glycopeptide treatment or discharge (whichever occurred later) using Health System perspective. Costs were assigned using the hospital's evaluation at the time of the study. Analyses made: multivariate, sensitivity (by modifying staff or acquisition costs) and simulation of reduction of stay by early discharge in the teicoplanin group. Study participants included 201 patients who had been using teicoplanin (n=100) or vancomycin (n=101) for at least four days. Data collected daily outside morning work timetable. Costs of acquisition, administration and monitoring by course of treatment (mean+/-SD, in euros) were lower in the vancomycin group (teicoplanin euro647.62+/-euro572.75 vs. vancomycin euro378.11+/-euro225.90); when total costs (including hospital stay) were considered, no differences were found (teicoplanin euro4,432.04+/-euro3,383.46 vs. vancomycin euro4,364.44+/-euro2,734.24). Conditions of use and results were similar for both antibiotics. The economic results of acquisition, administration and monitoring were advantageous for vancomycin; when global costs of care were taken into account, these differences were not evident. Tolerability was significantly advantageous in the teicoplanin group (with regard to phlebitis and elevation of creatininemia), without differences in clinical or economic outcomes. The formulation of teicoplanin did not take advantage of its potential benefits of administration.


Asunto(s)
Antibacterianos/economía , Costos de los Medicamentos/estadística & datos numéricos , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Teicoplanina/economía , Vancomicina/economía , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/efectos adversos , Antibacterianos/uso terapéutico , Análisis Costo-Beneficio , Vías de Administración de Medicamentos , Monitoreo de Drogas/economía , Utilización de Medicamentos/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Infecciones por Bacterias Grampositivas/economía , Costos de Hospital/estadística & datos numéricos , Hospitales Urbanos/economía , Hospitales Urbanos/estadística & datos numéricos , Humanos , Tiempo de Internación/economía , Masculino , Persona de Mediana Edad , Flebitis/inducido químicamente , Flebitis/epidemiología , Estudios Prospectivos , Diálisis Renal/economía , España/epidemiología , Teicoplanina/efectos adversos , Teicoplanina/uso terapéutico , Vancomicina/efectos adversos , Vancomicina/uso terapéutico
19.
Rev. esp. quimioter ; 19(1): 65-75, mar. 2006. tab
Artículo en En | IBECS | ID: ibc-047279

RESUMEN

El objetivo de este estudio, realizado en el Hospital Clínico San Carlos de Madrid, en España, fue comparar el coste del tratamiento de las infecciones por grampositivos con teicoplanina y vancomicina en la práctica clínica habitual. Mediante un diseño prospectivo observacional orientado al análisis de la utilización del fármaco y la valoración económica, se evaluó el grado de comparabilidad de la muestra, los efectos adversos, las características del tratamiento con teicoplanina/vancomicina y los factores que influyeron sobre la utilización de los recursos sanitarios hasta el final del tratamiento con el glucopéptido o el alta hospitalaria (tomando como referencia siempre lo que ocurriese más tarde) desde la perspectiva de los Servicios de Salud. Los costes se calcularon según la evaluación hospitalaria durante el periodo del estudio. Se realizó un análisis multivariado, de sensibilidad (modificando los costes de adquisición o relativos al personal sanitario) y de simulación de la reducción de la estancia hospitalaria por la anticipación del alta en el grupo tratado con teicoplanina. En el estudio participaron 201 pacientes tratados con teicoplanina (n=100) o vancomicina (n=101) durante al menos cuatro días. Toda la información relativa a los pacientes del estudio se recogió diariamente. Los costes de adquisición y administración del fármaco y de control de los pacientes durante el tratamiento (media ± DE, en euros) fueron menores en el grupo tratado con vancomicina (647,62 ± 572,75 para la teicoplanina frente a 378,11 ± 225,90 para la vancomicina); cuando se consideraron los costes globales, incluyendo la estancia hospitalaria, no se hallaron diferencias entre ambos grupos (4432,04 ± 3383,46 para la teicoplanina y 4364,44 ± 2734,24 para la vancomicina). Las condiciones de uso y los resultados obtenidos fueron similares con ambos antibióticos. El coste económico de la adquisición y administración del fármaco y del control de los pacientes fue menor en el grupo tratado con vancomicina, pero cuando se consideraron los costes globales incluyendo la estancia hospitalaria, fueron similares en ambos grupos. La tolerabilidad fue significativamente mejor en el grupo tratado con teicoplanina (con relación a la aparición de flebitis y elevaciones de la creatininemia), sin que existiesen diferencias en la eficacia clínica ni el coste económico. La formulación de teicoplanina no mostró ningún posible beneficio en cuanto a la administración


The objective of this study, conducted at Hospital Clínico San Carlos, Madrid, Spain, was to compare the cost of treatment of Gram-positive infections with teicoplanin and vancomycin under normal conditions. Using a prospective observational study design for drug utilization and economic assessment, we evaluated the comparability of the sample, adverse events, features of treatment with teicoplanin/vancomycin and factors influencing the consumption of resources until the end of glycopeptide treatment or discharge (whichever occurred later) using Health System perspective. Costs were assigned using the hospital’s evaluation at the time of the study. Analyses made: multivariate, sensitivity (by modifying staff or acquisition costs) and simulation of reduction of stay by early discharge in the teicoplanin group. Study participants included 201 patients who had been using teicoplanin (n = 100) or vancomycin (n = 101) for at least four days. Data collected daily outside morning work timetable. Costs of acquisition, administration and monitoring by course of treatment (mean ± SD, in euros) were lower in the vancomycin group (teicoplanin ;647.62 ± ;572.75 vs. vancomycin ;378.11 ± ;225.90); when total costs (including hospital stay) were considered, no differences were found (teicoplanin ;4,432.04 ± ;3,383.46 vs. vancomycin ;4,364.44 ± ;2,734.24). Conditions of use and results were similar for both antibiotics. The economic results of acquisition, administration and monitoring were advantageous for vancomycin; when global costs of care were taken into account, these differences were not evident. Tolerability was significantly advantageous in the teicoplanin group (with regard to phlebitis and elevation of creatininemia), without differences in clinical or economic outcomes. The formulation of teicoplanin did not take advantage of its potential benefits of administration


Asunto(s)
Masculino , Femenino , Adulto , Anciano , Persona de Mediana Edad , Humanos , Antibacterianos/economía , Costos de los Medicamentos/estadística & datos numéricos , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Teicoplanina/economía , Vancomicina/economía , Estudios de Seguimiento , Estudios Prospectivos , Antibacterianos/efectos adversos , Antibacterianos/uso terapéutico , Análisis Costo-Beneficio , Vías de Administración de Medicamentos , Monitoreo de Drogas/estadística & datos numéricos , Utilización de Medicamentos/estadística & datos numéricos , Infecciones por Bacterias Grampositivas/economía , Costos de Hospital/estadística & datos numéricos , Hospitales Urbanos/economía , Hospitales Urbanos/estadística & datos numéricos , Tiempo de Internación/economía , Flebitis/inducido químicamente , Flebitis/epidemiología , Diálisis Renal/economía , España/epidemiología , Teicoplanina/efectos adversos , Teicoplanina/uso terapéutico , Vancomicina/efectos adversos , Vancomicina/uso terapéutico
20.
Pharm World Sci ; 27(6): 459-64, 2005 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-16341954

RESUMEN

OBJECTIVE: The objective of this study was to compare the efficiency of linezolid versus teicoplanin in the treatment of bacteremia produced by Gram-positive microorganisms through a pharmacoeconomic analysis based on clinical results obtained from a previous clinical trial. METHODS: We applied an analysis of cost-effectiveness elaborated through a pharmacoeconomic model. We defined each unit of effectiveness as 'each successfully cured of infections with bacteremia.' We used the program Pharma-Decision (version Hospital 1.1) that allows to build interactive pharmacoeconomic models. Effectiveness data of both antibiotics were obtained from a published clinical trial, while resources consumed were obtained from the same source and from a consensus provided by a local expert panel. Only direct costs were included in the analysis without taking into consideration indirect costs. The perspective chosen was hospital assistance and the time horizon was set to 28 days. All costs are expressed in Euros. RESULTS: Linezolid demonstrated a better clinical outcome with less associated costs compared to teicoplanin (88.5 versus 56.7% of cured patients and 5,557.04 versus 6,327.43 per treated patient, respectively), thus resulting in a lower cost-effectiveness ratio for linezolid versus teicoplanin (6,279.1 versus 11,159.5 per cured patient with a 95% CI of 5,960.2-6,510.4 and 10,865.2-12,647.3, respectively) which results in a the dominant position for linezolid. The sensitivity analysis showed that linezolid was always the most efficient option even when modifying the value of variables with higher uncertainty. CONCLUSIONS: Linezolid is a more efficient option than teicoplanin because it presents higher rate of effectiveness with lower consumption of resources, thus being a dominant alternative in the treatment of Gram-positive infection with bacteremia.


Asunto(s)
Acetamidas/economía , Antiinfecciosos/economía , Infecciones por Bacterias Grampositivas/economía , Modelos Económicos , Oxazolidinonas/economía , Teicoplanina/economía , Acetamidas/uso terapéutico , Antiinfecciosos/uso terapéutico , Ensayos Clínicos como Asunto , Análisis Costo-Beneficio , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Costos de Hospital , Humanos , Linezolid , Oxazolidinonas/uso terapéutico , Teicoplanina/uso terapéutico
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