title: Cost-effectiveness of ampicillin/sulbactam versus imipenem/cilastatin in the treatment of limb-threatening foot infections in diabetic patients.
abstract: A cost-effectiveness analysis was performed following a double-blind, randomized study of ampicillin/sulbactam (A/S) versus imipenem/cilastatin (I/C) for the treatment of limb-threatening foot infections in 90 diabetic patients. There were no significant differences between the treatments in terms of clinical success rate, adverse-event frequency, duration of study antibiotic treatment, or length of hospitalization. Costs of the study antibiotics, treatment of failures and adverse events, and hospitalization were calculated. Mean per-patient treatment cost in the A/S group was $14,084, compared with $17,008 in the I/C group (P = .05), primarily because of lower drug and hospitalization costs and less-severe adverse events in the A/S group. Sensitivity analyses varying drug prices or hospital costs demonstrated that A/S was consistently more cost-effective than I/C. Varying the clinical success rate for each drug revealed that I/C would have to be 30% more effective than A/S to change the economic decisions.
authors.affiliation: Clinical Pharmacokinetics Laboratory, Millard Fillmore Health System, Buffalo, New York, USA.
authors.forename: P S
authors.initials: PS
authors.lastname: McKinnon
authors.forename: J A
authors.initials: JA
authors.lastname: Paladino
authors.forename: M L
authors.initials: ML
authors.lastname: Grayson
authors.forename: G W
authors.initials: GW
authors.lastname: Gibbons
authors.forename: A W
authors.initials: AW
authors.lastname: Karchmer
mesh_terms: D000328:Adult; D000368:Aged; D000667:Ampicillin / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D015377:Cilastatin / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D016527:Drug Costs; D004358:Drug Therapy / Q000191:economics*; D004359:Drug Therapy, Combination; D005534:Foot Diseases / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology*; D017721:Hospital Costs; D006760:Hospitalization; D006801:Humans; D015378:Imipenem / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010406:Penicillins / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D011480:Protease Inhibitors / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D013407:Sulbactam / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D013845:Thienamycins / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D011480:Protease Inhibitors; D013845:Thienamycins; D015377:Cilastatin; D015378:Imipenem; D000667:Ampicillin; D013407:Sulbactam