Cost effectiveness of ciprofloxacin plus metronidazole versus imipenem-cilastatin in the treatment of intra-abdominal infections.
OBJECTIVE
To compare the cost effectiveness of sequential intravenous (i.v.) to oral ciprofloxacin plus metronidazole (CIP/MTZ i.v./PO) with that of i.v. ciprofloxacin plus i.v. metronidazole (CIP/MTZ i.v.) and i.v. imipenem-cilastatin (IMI i.v.) in patients with intra-abdominal infections.


METHODS
Patients enrolled in a double-blind randomised clinical trial were eligible for inclusion into this cost-effectiveness analysis. Decision analysis was used to characterise the economic outcomes between groups and provide a structure upon which to base the sensitivity analyses. 1996 cost values were used throughout.


METHODS
The economic perspective of the analysis was that of a hospital provider.


RESULTS
Among 446 economically evaluable patients, 176 could be switched from i.v. to oral administration. The 51 patients randomised to CIP/MTZ i.v./PO who received active oral therapy had a success rate of 98%, mean duration of therapy of 9.1 days and mean cost of $US7678. There were 125 patients randomized to either CIP/MTZ i.v. or IMI i.v. who received oral placebo while continuing on active i.v. antibacterials; their success rate was 94%, mean duration of therapy was 10.1 days and mean cost was $US8774 (p = 0.029 vs CIP/MTZ i.v./PO). Of the 270 patients who were unable to receive oral administration, 97 received IMI i.v. and had a success rate of 75%, mean duration of therapy of 13.8 days and a mean cost of $US12,418, and 173 received CIP/MTZ i.v. and had a success rate of 77%, mean duration of therapy of 13.4 days and mean cost of $US12,219 (p = 0.26 vs IMI i.v.).


CONCLUSIONS
In patients able to receive oral therapy, sequential i.v. to oral treatment with ciprofloxacin plus metronidazole was cost effective compared with full i.v. courses of ciprofloxacin plus metronidazole or imipenem-cilastatin. In patients unable to receive oral therapy, no difference in mean cost was found between i.v. imipenem-cilastatin or i.v. ciprofloxacin plus i.v. metronidazole.
Walters
D J
DJ
Clinical Pharmacokinetics Laboratory, Millard Fillmore Suburban Hospital, Buffalo, New York, USA.
Solomkin
J S
JS
Paladino
J A
JA
D000005:Abdomen; D000368:Aged; D000890:Anti-Infective Agents / Q000191:economics* / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000191:economics*; D015377:Cilastatin / Q000191:economics* / Q000627:therapeutic use*; D002939:Ciprofloxacin / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D006801:Humans; D015378:Imipenem / Q000191:economics* / Q000627:therapeutic use*; D008297:Male; D008795:Metronidazole / Q000191:economics* / Q000627:therapeutic use*; D008875:Middle Aged; D011480:Protease Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D013845:Thienamycins / Q000191:economics* / Q000627:therapeutic use*
D000890:Anti-Infective Agents; D004338:Drug Combinations; D011480:Protease Inhibitors; D013845:Thienamycins; D008795:Metronidazole; D015377:Cilastatin; D002939:Ciprofloxacin; D015378:Imipenem