Pharmacoeconomic analysis of cefmenoxime dual individualization in the treatment of nosocomial pneumonia.
OBJECTIVE
To determine if dual individualization of cefmenoxime dosing is cost-effective.


METHODS
Retrospective, pharmacoeconomic decision analysis of two consecutively conducted prospective clinical studies.


METHODS
Patients with documented gram-negative nosocomial pneumonia were evaluated. Thirty-three patients received cefmenoxime at standard dosing and 28 patients received doses according to dual individualization methodology.


METHODS
Antibiotic and infection-related costs were compared between groups. The number of hospital antibiotic days and costs incurred on those days were also evaluated. A decision model was constructed to characterize differences in treatment outcome. Probabilities within the decision tree were derived from 61 evaluable patients. Cost-effectiveness and incremental cost-effectiveness ratios were calculated. Sensitivity analysis was performed by varying outcome probabilities, antibiotic prices, and hospital room costs.


RESULTS
Antibiotic and infection-related costs (mean +/- SEM) were $848 +/- 78 for standard cefmenoxime dosing and $1123 +/- 128 for dual individualization (p < 0.05). Total hospital costs were $10,660 +/- 1432 for standard dosing and $11,709 +/- 1900 for dual individualization (p > 0.05). Median antibiotic length of stay (ALOS) was 15.2 and 12.7 days for standard and dual individualization methodologies, respectively (p > 0.05). Incremental analysis of cost-effectiveness indicated that a similar reduction in length of stay for 259 dual individualization patients would save $321,808 annually.


CONCLUSIONS
Sensitivity analysis indicates that, by reducing ALOS, dual individualization could be a cost-effective method of beta-lactam dosing for patients with pneumonia. A prospective study should be conducted to validate these findings.
Paladino
J A
JA
State University of New York at Buffalo.
Fell
R E
RE
D015281:Cefmenoxime / Q000008:administration & dosage* / Q000191:economics*; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000188:drug therapy / Q000191:economics*; D003663:Decision Trees; D004334:Drug Administration Schedule; D016527:Drug Costs / Q000706:statistics & numerical data*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000191:economics; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D010865:Pilot Projects; D011014:Pneumonia / Q000188:drug therapy* / Q000191:economics*; D013997:Time Factors; D014481:United States
D015281:Cefmenoxime