title: The cost-effectiveness of cefepime plus metronidazole versus imipenem/cilastatin in the treatment of complicated intra-abdominal infection.
abstract: BACKGROUND
  Our objective was to compare the economic benefits of cefepime plus metronidazole with those of imipenem/cilastatin in the treatment of complicated intra-abdominal infections.
  
  
  METHODS
  We used a retrospective analysis of clinical outcomes and health resource utilization data collected during a randomized, double-blind, multi-center clinical trial. Seventeen university-affiliated hospitals in the United States and Canada participated, as did 323 patients with complicated intra-abdominal infections. Decision analysis was conducted using a decision node of cefepime vs. imipenem, and chance nodes that included an Acute Physiology and Chronic Health Evaluation (APACHE) II score of #15 versus .15; a need for posttreatment surgical procedures; and clinical outcomes. Effectiveness of treatment was measured by differences in the length and cost of hospital stays, the number and cost of surgical procedures after treatment, cure rates, and the cost of antibiotics. Also evalulated were the incremental costs of cure (i.e., the costs of additional cures).
  
  
  RESULTS
  Comparing cefepime plus metronidazole with imipenem/cilastatin, the expected cost of patient care was $8,218 versus $10,414, respectively, and the cost-effectiveness ratio per cure was $10,058 versus $13,685. For severely ill patients (APACHE II score .15), the expected cost was $12,962 versus $23,153, and the cost-effectiveness ratio per cure was $15,321 versus $64,313.
  
  
  CONCLUSIONS
  Cefepime plus metronidazole was more cost-effective than imipenem/cilastatin in the treatment of complicated intra-abdominal infections, primarily because of fewer post-treatment surgical procedures and shorter hospital stays. The primary advantage accrued to severely ill patients who had an APACHE II score .15.
authors.affiliation: Department of Surgery and Public Health, Weill Medical College of Cornell University, New York, New York, USA. pbarie@med.cornell.edu
authors.forename: Philip S
authors.initials: PS
authors.lastname: Barie
authors.forename: Ori D
authors.initials: OD
authors.lastname: Rotstein
authors.forename: E Patchen
authors.initials: EP
authors.lastname: Dellinger
authors.forename: Thaddeus H
authors.initials: TH
authors.lastname: Grasela
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Walawander
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D000077723:Cefepime; D002511:Cephalosporins / Q000191:economics* / Q000627:therapeutic use; D015377:Cilastatin / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D006801:Humans; D015378:Imipenem / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008795:Metronidazole / Q000191:economics* / Q000627:therapeutic use; D008875:Middle Aged; D011336:Probability; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D002511:Cephalosporins; D008795:Metronidazole; D015377:Cilastatin; D015378:Imipenem; D000077723:Cefepime