[Hospital management of patients with complicated intra-abdominal infections: pharmacoeconomic evaluations].
Due to their high incidence and large resource consumption, complicated intra-abdominal infections (cIAIs) represent a heavy burden for the Italian National Health System (NHS) and the Italian society, with estimated annual costs of 1,5 and 3 billions Euro, respectively. The different strategies, monotherapy or antibiotic combinations, indicated for treating cIAIs induce significantly different acquisition and administration costs but substantially equivalent therapeutic results, with average clinical effectiveness rates of 70-80%. This apparent equivalence among different antibiotic protocols presumably depends on the widespread trend to individualize the therapeutic strategy according to the clinical severity and the community or nosocomial origin of cIAIs, as well as on some degree of non-appropriateness when empirically choosing a first-line antibiotic. The average cost for the nosocomial management of cIAI patients depends on several factors: posology and antibiotic drug acquisition and administration costs, days of antibiotic therapy, mix of antibiotic schedules, rates of the therapeutic failures that induce further drug consumption, prolong hospitalization and often require re-intervention and ICU utilization. The introduction in the therapeutic arsenal of a new antibiotic like tigecycline leads to a mild increase of the average antibiotic acquisition and treatment costs per patient: this increase is proportional to the percentage of patients treated with the new antibiotic. According to a decisional model, implemented on international outcome data and Italian costs, the mean cost for first-line antibiotic acquisition and the mean cost for first- and second-line antibiotic treatment represent respectively only 2% and 8% of the mean overall hospitalization cost. The mean hospitalization cost estimated by the model is noticeably higher than the mean value of DRG tariffs presumably reimbursed by the Italian NHS to hospitals for cIAI-related hospitalizations. Greater overall efficiency levels in the nosocomial management of cIAI patients are achievable mainly through the reduction of non-appropriateness rates in first line antibiotic choices and better treatment individualization, possible if the physician is offered the choice of as many valid therapeutic options as possible, in order to guarantee the best cure chances to each patient.
Eandi
Mario
M
Istituto di Farmacologia, Universita degli Studi di Torino, Italy.
D034841:Abdominal Cavity; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics* / Q000494:pharmacology / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy / Q000191:economics; D004066:Digestive System Diseases / Q000188:drug therapy* / Q000191:economics* / Q000382:microbiology; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007362:Intensive Care Units / Q000191:economics; D007558:Italy; D017410:Practice Guidelines as Topic
D000900:Anti-Bacterial Agents