Cost effectiveness of cephalosporin monotherapy and aminoglycoside/ureidopenicillin combination therapy. For the treatment of febrile episodes in neutropenic patients.
OBJECTIVE
To assess the relative cost effectiveness of cephalosporin monotherapy options and aminoglycoside/ureidopenicillin combination therapy for the treatment of febrile episodes in adult patients with neutropenia.


METHODS
This was a retrospective cost-effectiveness analysis conducted from the institutional perspective.


METHODS
The analysis was based on 741 febrile episodes in adult patients with neutropenia enrolled in 5 randomised trials: 3 comparing monotherapy with ceftazidime or cefepime, and 2 comparing cefepime monotherapy versus aminoglycoside/ureidopenicillin combination therapy. Resource utilisation included costs for study antibacterials, treatment of adverse effects and failures, and hospitalisation. The primary end-point was the overall cost of treatment per patient. Cost-effectiveness ratios were also analysed.


RESULTS
No significant differences in clinical success rates were detected. Median per-patient costs in the monotherapy comparisons were $US7849 for cefepime and $US7788 for ceftazidime [1997 values; not significantly different (NS)]. Corresponding costs for the monotherapy versus combination therapy comparisons were $US9780 for cefepime and $US10 159 for gentamicin/ureidopenicillin (NS). Despite a higher acquisition cost for cefepime, there were no statistically significant differences in cost effectiveness compared with either ceftazidime monotherapy or gentamicin/ureidopenicillin combination therapy. Sensitivity analyses revealed that monotherapy can be cost effective compared with combination therapy in many situations.


CONCLUSIONS
There were no economic differences between the 3 regimens tested. Therefore drug cost should not be a deciding factor when choosing antibacterial therapy for the treatment of febrile episodes in adult patients with neutropenia.
Paladino
J A
JA
The Clinical Pharmacokinetics Laboratory Millard Fillmore Hospitals, Buffalo, New York 14221, USA. jpaladino@kaleidahealth.org
Fong
L D
LD
Forrest
A
A
Ramphal
R
R
D000617:Aminoglycosides / Q000008:administration & dosage*; D002511:Cephalosporins / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005334:Fever / Q000188:drug therapy*; D017048:Health Care Costs; D006801:Humans; D009503:Neutropenia / Q000150:complications*; D010406:Penicillins / Q000008:administration & dosage*; D012189:Retrospective Studies
D000617:Aminoglycosides; D002511:Cephalosporins; D010406:Penicillins