Cost efficacy of tazobactam/piperacillin versus imipenem/cilastatin in the treatment of intra-abdominal infection.
OBJECTIVE
To compare the cost, efficacy and cost efficacy of tazobactam/piperacillin and imipenem/cilastatin in the treatment of intra-abdominal infection.


METHODS
The analysis was retrospective and based on a decision tree. Effectiveness data were obtained from 19 published clinical trials. Direct costs were quantified per patient from the time the decision was made to administer the antibacterial to the end of the first course of treatment or the end of a subsequent course of treatment, if required. The primary end-point was the cost per successfully treated patient. The cost per life saved was also analysed. Various follow-up times were taken into account.


CONCLUSIONS
German National Health Insurance funds.


METHODS
1744 patients with intra-abdominal infection.


METHODS
Tazobactam/piperacillin (total daily dosage of 13.5 g/day) and imipenem/cilastatin (total daily dosage of 1.5 to 4 g/day). The mean duration of treatment varied from 5.5 to 8.2 days for tazobactam/piperacillin and 5 to 9.4 days for imipenem/cilastatin.


RESULTS
Compared with imipenem/cilastatin, treatment with tazobactam/piperacillin was more effective and the overall treatment costs were lower. In the base-case analysis, the cost-efficacy ratio (cost per successfully treated patient) was 7881 German deutschmarks (DM) for tazobactam/piperacillin and DM11,390 for imipenem/cilastatin. The incremental cost-efficacy ratio (per life saved) varied between -DM72,567 and -DM350,738 for tazobactam/piperacillin. Sensitivity analyses revealed that the results were robust against various assumptions on cost parameters, clinical outcomes and length of treatment. All costs reflect 1998 values; $US1 = DM1.85.


CONCLUSIONS
This study suggests that compared with imipenem/cilastatin, tazobactam/piperacillin is more cost efficacious in the treatment of intra-abdominal infections and that it offers a cost advantage through fewer relapses and lower daily therapeutic costs.
Institute of Environmental Medicine and Hospital Epidemiology, University Hospital, Freiburg, Germany.
E S
ES
Dietrich
B
B
Schubert
W
W
Ebner
F
F
Daschner
D000005:Abdomen / Q000382:microbiology; D000328:Adult; D001424:Bacterial Infections / Q000188:drug therapy / Q000191:economics*; D015377:Cilastatin / Q000191:economics* / Q000627:therapeutic use; D000077728:Cilastatin, Imipenem Drug Combination; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D004338:Drug Combinations; D016527:Drug Costs; D004359:Drug Therapy, Combination / Q000191:economics* / Q000627:therapeutic use; D017048:Health Care Costs; D006801:Humans; D015378:Imipenem / Q000191:economics* / Q000627:therapeutic use; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000191:economics* / Q000627:therapeutic use; D010878:Piperacillin / Q000191:economics* / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D011480:Protease Inhibitors / Q000191:economics* / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D013845:Thienamycins / Q000191:economics* / Q000627:therapeutic use
D004338:Drug Combinations; D011480:Protease Inhibitors; D013845:Thienamycins; D015377:Cilastatin; D000077725:Piperacillin, Tazobactam Drug Combination; D015378:Imipenem; D010397:Penicillanic Acid; D000077728:Cilastatin, Imipenem Drug Combination; D010878:Piperacillin