Pharmacoeconomics of aztreonam-clindamycin versus gentamicin-clindamycin in the treatment of penetrating abdominal injury.
OBJECTIVE
To evaluate the pharmacoeconomic implications of using aztreonam-clindamycin (A-C) versus gentamicin-clindamycin (G-C) from the perspective of the hospital and pharmacy directors.


METHODS
Pharmacoeconomic analysis performed at one of the sites participating in the prospective, randomized, double-blind, comparative, multicenter efficacy study.


METHODS
Referral hospital with level 1 trauma center.


METHODS
Eight-five adults with a suspected penetrating intraabdominal injury requiring laparotomy.


METHODS
Patients were randomized to receive aztreonam 2 g intravenously every 8 hours or gentamicin 2 mg/kg intravenous load followed by 5 mg/kg/day intravenously initially adjusted to peak concentrations of 6-8 micrograms/ml. All patients received clindamycin 900 mg intravenously every 8 hours.


RESULTS
Charge data were gathered from the hospital billing system and converted to cost data using an institutional cost:charge ratio of 0.6. Study drug and aminoglycoside monitoring costs were also calculated. Overall, 43 (97%) of 44 patients receiving A-C had a favorable clinical response compared with 35 (85.4%) of 41 receiving G-C (p = 0.052). The mean hospital cost of $66,336 for 7 infected patients was significantly higher than that of $8014 in 78 noninfected patients (p < 0.0001). Mean hospital costs of $12,058 and $13,742 for A-C and G-C groups, respectively, were not significantly different (p > 0.05) despite having only a single failure (total cost $162,666) in the A-C group. Similarly, mean pharmacy costs of $1411 and $1604, respectively, were not significantly different (p > 0.05).


CONCLUSIONS
Hospital costs for infected patients with penetrating abdominal trauma exceed those of noninfected patients by 5-fold. Despite a lower infection rate in the A-C group, neither hospital nor pharmacy costs were significantly different compared with those in the G-C group.
Fabian
T C
TC
Department of Surgery, University of Tennessee, Memphis 38163, USA.
Boucher
B A
BA
Croce
M C
MC
D000007:Abdominal Injuries / Q000188:drug therapy* / Q000191:economics*; D000328:Adult; D001398:Aztreonam / Q000191:economics* / Q000627:therapeutic use*; D002981:Clindamycin / Q000191:economics* / Q000627:therapeutic use*; D016527:Drug Costs; D004359:Drug Therapy, Combination / Q000191:economics* / Q000627:therapeutic use*; D005260:Female; D005839:Gentamicins / Q000191:economics* / Q000627:therapeutic use*; D017048:Health Care Costs; D006745:Hospital Bed Capacity, 300 to 499; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013714:Tennessee
D005839:Gentamicins; D002981:Clindamycin; D001398:Aztreonam